NPIMap

Organization Active NPI

Southern Pediatric Therapy

  • Pediatric Occupational Therapist
  • Hernando, MS
National Provider Identifier
1063985885
Registry record updated Jan 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Legal business name
SOUTHERN PEDIATRIC THERAPY
Practice address
1772 Carlee Dr
Hernando, MS 38632-8844
Phone
(662) 469-2906
NPI assigned
Jan 3, 2019
Last updated
Jan 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Pacileo, OTR/LNPI 1356822795
Title
Owner
Phone
(662) 469-2906

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X NU Primary

Addresses

Primary practice location

1772 Carlee Dr
Hernando, MS 38632-8844

Mailing address

PO Box 441
Hernando, MS 38632-0441

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546473600000",
    "number": "1063985885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 441",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386320441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1772 CARLEE DR",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386328844",
            "telephone_number": "662-469-2906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-03",
        "last_updated": "2019-01-03",
        "status": "A",
        "authorized_official_last_name": "PACILEO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-469-2906",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hernando, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.