Basic Information
| Provider Information | |||||||||
| NPI: | 1619267226 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGGETT | ||||||||
| FirstName: | COURTNEY | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 COPPER RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390734701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015030916 | ||||||||
| FaxNumber: | 6015030916 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392022064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019681000 | ||||||||
| FaxNumber: | 6019681000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2011 | ||||||||
| LastUpdateDate: | 11/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | TA2342 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.