Individual
MRS. KECIA SPENCER RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.R.
Contact information
Practice address
1635 BOLING ST, JACKSON, MS 39213-4418
(601) 366-0123
(601) 366-0649
Mailing address
1635 BOLING ST, JACKSON, MS 39213-4418
(601) 366-0123
(601) 366-0649
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT1337
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9015618
—
MS
Enumeration date
03/17/2008
Last updated
03/17/2008
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