Individual
MARY CAMILLE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
2319 HIGHWAY 145, SALTILLO, MS 38866-9199
(662) 869-9970
(662) 869-9980
Mailing address
2319 HWY 145, SALTILLO, MS 38866
(662) 869-9970
(662) 869-9980
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0669
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07857321
—
MS
Enumeration date
01/31/2007
Last updated
09/01/2015
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