Individual
JO CHANTELL MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
90 A CLARK BOULEVARD, TUPELO, MS 38801-3592
(662) 840-0535
(662) 842-7915
Mailing address
PO BOX 3592, TUPELO, MS 38803-3592
(662) 840-0535
(662) 842-7915
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1959
MS
Other
Enumeration date
12/18/2009
Last updated
10/02/2020
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