Individual
CONNIE FOWLKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
310 EMERALD DR, COLUMBUS, MS 39702-5526
(662) 244-8823
Mailing address
310 EMERALD DR, COLUMBUS, MS 39702-5526
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA3116
MS
Other
Enumeration date
03/16/2016
Last updated
03/16/2016
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