Individual
TISHA NICOLE RADICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1530 BROAD AVE, GULFPORT, MS 39501-3601
(228) 864-6544
Mailing address
3715 WASHINGTON AVE, GULFPORT, MS 39507-3123
(228) 860-9293
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3549
MS
Other
Enumeration date
09/14/2024
Last updated
09/14/2024
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