Basic Information
| Provider Information | |||||||||
| NPI: | 1699105833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID SOUTH REHAB SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 AVIGNON DR | ||||||||
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| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39157 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 711 AVIGNON DR | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016056777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2013 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | MORGAN | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
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| AuthorizedOfficialTitleorPosition: | HR REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 6016056777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT2824 | MS | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.