Individual
TAYLOR CRAVEN GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
90 CLARK BLVD STE A, TUPELO, MS 38804-2801
(662) 840-0535
(662) 842-7915
Mailing address
PO BOX 3592, TUPELO, MS 38803-3592
(662) 840-0535
(662) 842-7915
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2914
MS
Other
Enumeration date
08/20/2019
Last updated
08/20/2019
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