Individual
MARTHA MARIE WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OT
Contact information
Practice address
109 HONEYSUCKLE AVE, POPLARVILLE, MS 39470-2009
(601) 916-5741
Mailing address
109 HONEYSUCKLE AVE, POPLARVILLE, MS 39470-2009
(601) 916-5741
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
OT2125
MS
225XP0200X
Pediatric Occupational Therapist
Primary
OT2125
MS
Other
Enumeration date
03/20/2014
Last updated
03/20/2014
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