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Individual

NASH BURNSIDE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
COTA

Contact information

Practice address
201 BAKER BLVD, LELAND, MS 38756-3401
(662) 686-4121
(662) 686-4770
Mailing address
201 BAKER BLVD, LELAND, MS 38756-3401
(662) 686-4121
(662) 686-4770

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2717
MS

Other

Enumeration date
07/17/2017
Last updated
07/21/2022
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