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1083975320
KANEISHA INGRAM
JACKSON, MS
NPI
1083975320
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: MS TA2678)
Enumeration Date
2012-06-04
Last Update Date
2012-06-04
Business Address
MISS KANEISHA INGRAM COTA
1873 LONGWOOD DR
JACKSON, MS 39212-2509
Phone number: 601-966-2418
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Mailing Address
MISS KANEISHA INGRAM COTA
1873 LONGWOOD DR
JACKSON, MS 39212-2509
Phone number:
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