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Individual

DR. COZETTA MARIE MCMILLIAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTD, OTR/L

Contact information

Practice address
107 MEADOW LN, JACKSON, MS 39212-3525
(601) 209-6453
Mailing address
107 MEADOW LN, JACKSON, MS 39212-3525

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
13451
CA
225X00000X
Occupational Therapist
310303
LA
225X00000X
Occupational Therapist
Primary
4575
SC
225X00000X
Occupational Therapist
4779
AL
225X00000X
Occupational Therapist
OT19612
FL

Other

Enumeration date
01/03/2019
Last updated
01/03/2019
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