Individual
MRS. DOROTHY MICHELE FULGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
130 PARKWAY PLZ, KOSCIUSKO, MS 39090-3217
(662) 289-3588
(662) 289-2486
Mailing address
PO BOX 23996, JACKSON, MS 39225-3996
(601) 206-6100
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1622
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00273305
—
MS
Enumeration date
04/11/2006
Last updated
04/08/2013
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