Organization
SOUTHERN PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PACILEO OTR/L (OWNER)
(662) 469-2906
Entity
Organization
Contact information
Practice address
1772 CARLEE DR, HERNANDO, MS 38632-8844
(662) 469-2906
Mailing address
PO BOX 441, HERNANDO, MS 38632-0441
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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