Individual
LAURA CHISHOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
206 MARYLAND AVE, MCCOMB, MS 39648-3926
(601) 250-4815
Mailing address
5009 NICHOLAS DR, TEXARKANA, TX 75503-4928
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
205617
TX
224Z00000X
Occupational Therapy Assistant
OTA166
AR
Other
Enumeration date
11/20/2007
Last updated
11/20/2007
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