Individual
KEELY FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1102 ROSE ST, PRENTISS, MS 39474-5200
(601) 792-1242
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT3495
MS
Other
Enumeration date
04/20/2020
Last updated
04/20/2020
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