Individual
SANDIFER GRAY MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4109 HWY 98 W, SUMMIT, MS 39666
(601) 276-3900
Mailing address
106 SMITH ST, RAYVILLE, LA 71269-2938
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
200061
LA
Other
Enumeration date
03/02/2009
Last updated
03/02/2009
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