Individual
MRS. LISA BASS HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
6250 OLD CANTON RD STE 130, JACKSON, MS 39211-2946
(601) 956-7280
(601) 977-6244
Mailing address
965 RIDGE LAKE BLVD STE 103, MEMPHIS, TN 38120-9446
(901) 227-3255
(901) 227-3205
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0196
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00576267
—
MS
Enumeration date
01/12/2011
Last updated
03/15/2018
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