Individual
SANDY HEATH COCKRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 HIGHWAY 12 W, KOSCIUSKO, MS 39090-3208
(318) 649-6181
Mailing address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
(601) 276-3900
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2086
MS
Other
Enumeration date
11/02/2016
Last updated
11/02/2016
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