Organization
ABC PEDIATRIC THERAPY OF MISSISSIPPI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA WHALUM OTD, OTR/L (OCCUPATIONAL THERAPIST)
(662) 536-6884
Entity
Organization
Contact information
Practice address
1130 STATELINE RD E STE D-E, SOUTHAVEN, MS 38671-8700
(662) 536-6884
(662) 510-5892
Mailing address
1130 STATELINE RD E STE D-E, SOUTHAVEN, MS 38671-8700
(662) 536-6884
(662) 510-5892
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
07/24/2023
Last updated
01/30/2024
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