Autumn Elise Birdsong, OTR/L
Individual provider Active NPI Occupational Therapist · McComb, MS
NPI 1093371577 · NPPES record last updated Jun 10, 2019
Key facts
- NPI
- 1093371577
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT2119 (MS)
- Practice address
- 1301A Harrison Ave
McComb, MS 39648-2829 - Phone
- (601) 250-5455
- Fax
- (601) 250-5453
- NPI assigned
- May 10, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Professional Rehab Associates
Practice addresses (Care Compare)
1301 A Harrison Ave
McComb, MS 39648-2829
Phone (601) 250-5455
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190708000853 | MS | Practitioner - Occupational Therapist in Private Practice | 4284969668 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT2119 | MS | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Rehab Associates | Occupational Therapist | Current |
Accepting new patients |
Locations
631 Brookway Blvd
Brookhaven, MS 39601
Phone (601) 833-7317
1301A Harrison Ave
McComb, MS 39648
Phone (601) 248-2825
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT2119 | MS | Yes |
Addresses
Primary practice location
1301A Harrison Ave
McComb, MS 39648-2829
Mailing address
1301A Harrison Ave
McComb, MS 39648-2829
Phone (601) 250-5455
Other providers in McComb, MS
- Bert S. Haydel
- Ellanie L Bessonette
- Bigner Health LLC
- Marty Bigner
- Casandra Bingham
- Beverly Birdsong
- Reneshia Blakney
- Marissa Blalock
- Kyla Bland
- Blessed Haven Independent Living LLC
All providers in McComb, MS · Occupational Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.