Individual
MR. KEVIN ALAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L, CHT
Contact information
Practice address
206B OXFORD RD, NEW ALBANY, MS 38652-3115
(662) 534-4445
(662) 534-9449
Mailing address
206B OXFORD RD, NEW ALBANY, MS 38652-3115
(662) 534-4445
(662) 534-9449
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0359
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06957897
—
MS
01
—
582681044
TAX ID
MS
Enumeration date
11/29/2006
Last updated
03/26/2009
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