Individual
MISS QULANTA MONETE CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1220 JEFFERSON ST, LAUREL, MS 39440-4355
(601) 426-4119
(601) 426-4768
Mailing address
1349 COUNTY ROAD 17, BAY SPRINGS, MS 39422
(601) 764-2384
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
TA2073
MS
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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