Individual
PHYLLIS SMITH-BOWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1475 MOSSLINE DR, JACKSON, MS 39211-2819
(601) 942-5051
Mailing address
1475 MOSSLINE DR, JACKSON, MS 39211-2819
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0499
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06102222
—
MS
Enumeration date
06/28/2006
Last updated
07/08/2007
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