Individual
MR. JOSEPH ALBERT CHURCH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L-CHT
Contact information
Practice address
1105 39TH AVE, GULFPORT, MS 39501-2654
(228) 575-4654
(228) 575-4651
Mailing address
1105 39TH AVE, GULFPORT, MS 39501-2654
(228) 575-4654
(228) 575-4651
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
OT0116
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119593
—
MS
Enumeration date
06/04/2006
Last updated
01/29/2013
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