Individual
STACEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2655 LAKELAND DR, JACKSON, MS 39232-9516
(601) 714-2230
Mailing address
11581 ROAD 701, UNION, MS 39365-5262
(601) 663-5112
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1431
MS
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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