Individual
MIRANDA WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
630 S MAIN ST, WATER VALLEY, MS 38965-3468
(662) 473-5947
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT3520
MS
Other
Enumeration date
01/28/2019
Last updated
01/28/2019
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