Individual
MIRANDA PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1608 MAMIE ST, HATTIESBURG, MS 39401-6227
(601) 928-1889
Mailing address
1608 MAMIE ST, HATTIESBURG, MS 39401-6227
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2674
MS
Other
Enumeration date
06/20/2016
Last updated
06/20/2016
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