Individual
MRS. KATIE OGLETREE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1350 E WOODROW WILSON AVE, JACKSON, MS 39216-5112
(601) 981-2611
Mailing address
1350 E WOODROW WILSON AVE, JACKSON, MS 39216-5112
(601) 981-2611
Taxonomy
Speciality
Code
Description
License number
State
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
1731
MS
Other
Enumeration date
06/01/2008
Last updated
06/01/2008
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