Active NPI
Mylissa Hodges
- Occupational Therapist
- Kosciusko, MS
National Provider Identifier
1265729636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT0682
- Practice address
- 310 Autumn Ridge Dr
Kosciusko, MS 39090-3242 - Phone
- (662) 289-3499
- NPI assigned
- Jul 6, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT0682 | MS | Primary |
Addresses
Primary practice location
310 Autumn Ridge Dr
Kosciusko, MS 39090-3242
Mailing address
4109 Highway 98 W
Summit, MS 39666-9132
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT0682 | MS | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309910400000",
"number": "1265729636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4109 HIGHWAY 98 W",
"city": "SUMMIT",
"state": "MS",
"postal_code": "396669132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 AUTUMN RIDGE DR",
"city": "KOSCIUSKO",
"state": "MS",
"postal_code": "390903242",
"telephone_number": "662-289-3499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HODGES",
"first_name": "MYLISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-06",
"last_updated": "2011-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MS",
"license": "OT0682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kosciusko, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.