1376251876 NPI number — JESSICA FERRELL OT

Table of content: JESSICA FERRELL OT (NPI 1376251876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376251876 NPI number — JESSICA FERRELL OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRELL
Provider First Name:
JESSICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376251876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
921 W BEACON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39350-3229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-650-0002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9993 HIGHWAY 501
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39074-9424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-207-7497
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT-3499 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OT3499 . This is a "OT LICENSE NUMBER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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