Individual
WANDA FELECIA HUSBAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10 MEDICAL BLVD, HATTIESBURG, MS 39401-7230
(601) 264-0357
Mailing address
114 RAY BRIDGE DR, HATTIESBURG, MS 39402-1101
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2234
MS
Other
Enumeration date
11/16/2009
Last updated
11/16/2009
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