Individual
RAELYN TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
83 AIRWAYS PL, SOUTHAVEN, MS 38671-5885
(662) 349-8787
Mailing address
83 AIRWAYS PL, SOUTHAVEN, MS 38671-5885
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8471
TN
Other
Enumeration date
03/03/2026
Last updated
03/03/2026
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