Individual
CANDICE FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2475 LAKELAND DR STE A, JACKSON, MS 39232-9505
(601) 636-6019
(601) 661-8457
Mailing address
1054 HIGHLAND COVE PL, RIDGELAND, MS 39157-1523
(601) 636-6019
(601) 661-8457
Taxonomy
Speciality
Code
Description
License number
State
225XR0403X
Driving and Community Mobility Occupational Therapist
Primary
OT2019
MS
Other
Enumeration date
10/19/2006
Last updated
07/08/2007
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