Individual
MRS. STACEY S VOLLENWEIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
311 N MAIN ST, PICAYUNE, MS 39466-3313
(601) 799-4065
(601) 620-4117
Mailing address
7533 CROOKED STICK DR, DIAMONDHEAD, MS 39525-3895
(228) 216-9996
(601) 620-4117
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1249
MS
225XP0200X
Pediatric Occupational Therapist
OT1249
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06524202
—
MS
Enumeration date
07/21/2011
Last updated
12/31/2014
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