Individual
AMY POLITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2210 MILL STREET EXT STE B, LUCEDALE, MS 39452-6079
(601) 947-9005
(601) 947-9007
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
OT2078
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090-15077
MEDICAID GROUP
MS
01
—
C02726
MEDICARE GROUP
MS
Enumeration date
11/29/2007
Last updated
03/13/2009
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