Individual
CHRISTINE FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3131 N HIGHLAND AVE, JACKSON, TN 38305-3418
(731) 410-1505
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5046
TN
Other
Enumeration date
01/02/2018
Last updated
01/02/2018
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