Individual
MISS KELLY MACKENZIE BRISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
PO BOX 457, MONTICELLO, MS 39654-0457
(601) 587-2563
(601) 587-0472
Mailing address
PO BOX 457, MONTICELLO, MS 39654-0457
(601) 587-2563
(601) 587-0472
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-4021
MS
Other
Enumeration date
08/21/2024
Last updated
08/21/2024
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