Basic Information
Provider Information
NPI: 1275683450
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CUYLER
FirstName: ROSIE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: COTA-L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 207 JORDAN HILL RD
Address2:  
City: CARSON
State: MS
PostalCode: 394276330
CountryCode: US
TelephoneNumber: 6017924570
FaxNumber:  
Practice Location
Address1: 711 AVIGNON DR
Address2:  
City: RIDGELAND
State: MS
PostalCode: 391575120
CountryCode: US
TelephoneNumber: 6016056777
FaxNumber: 6016058869
Other Information
ProviderEnumerationDate: 01/11/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
224Z00000XTA1424MSY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant 

No ID Information.


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