Individual
JOHN MICHAEL PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
103 MEDICAL PARK, HATTIESBURG, MS 39401-9042
(601) 268-5757
(601) 579-5220
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5757
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08425764
—
MS
Enumeration date
06/04/2015
Last updated
07/17/2020
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