Organization
FUNCTIONAL THERAPY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIKOLAS DOYLE CARNATHAN OTR/L (PRESIDENT)
(662) 844-4471
Entity
Organization
Contact information
Practice address
499 GLOSTER CREEK VLG, SUITE I-3, TUPELO, MS 38801-4600
(662) 844-4471
(662) 844-4472
Mailing address
499 GLOSTER CREEK VLG, SUITE I-3, TUPELO, MS 38801-4600
(662) 844-4471
(662) 844-4472
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00304504
—
MS
Enumeration date
10/31/2005
Last updated
08/22/2020
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