Organization
MAGNOLIA PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE AUSTIN OTR/L (OCCUPATIONAL THERAPIST)
(601) 519-8930
Entity
Organization
Contact information
Practice address
239 CLARK FARMS RD, MADISON, MS 39110-8115
(601) 519-8930
Mailing address
239 CLARK FARMS RD, MADISON, MS 39110-8115
(601) 519-8930
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1767
MS
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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