Provider Demographics
NPI:1831357128
Name:FARRIS, AFTON ANDREWS (OT)
Entity type:Individual
Prefix:
First Name:AFTON
Middle Name:ANDREWS
Last Name:FARRIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AFTON
Other - Middle Name:LEANNE
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8419
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-8087
Mailing Address - Country:US
Mailing Address - Phone:228-388-5714
Mailing Address - Fax:228-388-0017
Practice Address - Street 1:2210 MILL STREET EXT STE B
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6079
Practice Address - Country:US
Practice Address - Phone:601-947-9005
Practice Address - Fax:601-947-9007
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS090-15077OtherMEDICAID GROUP
MSC02726OtherMEDICARE GROUP
MS1033218524OtherGROUP NPI
MS256545OtherMEDICARE PART A GROUP