Individual
JORDAN WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10 MEDICAL BLVD, HATTIESBURG, MS 39401-7230
(601) 543-0310
Mailing address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2546
MS
Other
Enumeration date
12/21/2011
Last updated
12/21/2011
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