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Individual

MS. JENNIFER EMILY BASS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
275 MORNING VIEW LANE, MANTACHIE, MS 38855-7096
(662) 255-0161
Mailing address
275 MORNINGVIEW LN, MANTACHIE, MS 38855-7096
(662) 255-0161

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
TA2283
MS

Other

Enumeration date
09/17/2010
Last updated
09/17/2010
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