Individual
MR. ANTHONY JAY EZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTAL
Contact information
Practice address
113 MAIN ST., MEADVILLE, MS 39653
(601) 384-1898
(601) 384-1878
Mailing address
9230 BERRYTOWN RD SE, MEADVILLE, MS 39653-9035
(601) 384-1562
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA1041
MS
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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