Individual
AMI C MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1800 BEACH DR, PT DEPARTMENT, GULFPORT, MS 39507-1553
(228) 897-4452
(228) 388-0017
Mailing address
PO BOX 8419, BILOXI, MS 39535-8087
(228) 388-5714
(228) 388-0017
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2632
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05638788
MEDICAID
MS
Enumeration date
12/10/2012
Last updated
03/28/2013
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