Individual
TITUS JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
573 CHESTERVILLE RD APT 79, TUPELO, MS 38801-1514
(601) 543-8216
Mailing address
573 CHESTERVILLE RD APT 79, TUPELO, MS 38801-1514
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2250
MS
Other
Enumeration date
11/09/2011
Last updated
11/09/2011
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