Individual
EMILY LIDDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
7712 OLD CANTON RD, MADISON, MS 39110-9299
(601) 427-5775
Mailing address
1535 WINCHESTER ST, JACKSON, MS 39211-5641
(662) 590-5842
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT3496
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508125899
GROUP FOR A FOCUSED BRAIN, LLC
—
Enumeration date
08/02/2018
Last updated
08/02/2018
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