Basic Information
| Provider Information | |||||||||
| NPI: | 1881746683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCLAIN | ||||||||
| FirstName: | ADRIA | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13861 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392363861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016055384 | ||||||||
| FaxNumber: | 6018984761 | ||||||||
| Practice Location | |||||||||
| Address1: | 665 HIGHWAY 51 STE C | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391572136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016055384 | ||||||||
| FaxNumber: | 6018984761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235500000X | OT0128 | MS | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist |
ID Information
| ID | Type | State | Issuer | Description | 00126476 | 05 | MS | MEDICAID | 06081560 | 05 | MS | MEDICAID |