Keely Fortenberry
Occupational Therapist in Prentiss, MS. Individual provider (NPI-1).
NPI number1336769306
StatusActive
Last updated in NPPESApr 20, 2020
Details
- NPI
- 1336769306
- Entity type
- Individual (NPI-1)
- Name
- Keely Fortenberry
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 20, 2020
- Certification date
- Apr 20, 2020
- Last updated
- Apr 20, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | OT3495 | MS | Yes |
Practice location
1102 Rose StPrentiss, MS 39474-5200
Phone 601-792-1242
Mailing address
711 Avignon DrRidgeland, MS 39157-5120
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