Individual
MADISON BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
433 MAIN ST, LEAKESVILLE, MS 39451-6502
(601) 394-4545
(601) 394-4546
Mailing address
42465 HIGHWAY 195, HALEYVILLE, AL 35565-7052
(256) 350-1764
(256) 355-0884
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT4157
MS
Other
Enumeration date
07/12/2024
Last updated
07/12/2024
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