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Organization

FUNDAMENTAL THERAPY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SARA CARR BRADDY MOTR/L (OCCUPATIONAL THERAPIST)
(601) 916-8329
Entity
Organization

Contact information

Practice address
311 N MAIN ST, PICAYUNE, MS 39466-3313
(601) 799-4065
(601) 620-4117
Mailing address
20 NEWT MITCHELL RD, PICAYUNE, MS 39466-9224

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT2316
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05587048
MS
Enumeration date
02/25/2014
Last updated
01/10/2015
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