Active NPI
Specialized Therapy Services, LLC
- Occupational Therapist
- Hattiesburg, MS
National Provider Identifier
1396903209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT0493
- Legal business name
- SPECIALIZED THERAPY SERVICES, LLC
- Practice address
- 16 Office Park Dr
Suite 21
Hattiesburg, MS 39402-6020 - Phone
- (601) 296-9191
- Fax
- (601) 296-9190
- NPI assigned
- May 28, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Mandy K Brunson
- Title
- Office Manager
- Phone
- (601) 296-9191
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT0932 | MS | |
| Occupational Therapist | 225X00000X | OT0493 | MS | Primary |
Addresses
Primary practice location
16 Office Park Dr
Suite 21
Hattiesburg, MS 39402-6020
Mailing address
16 Office Park Dr
Suite 21
Hattiesburg, MS 39402-6020
Phone (601) 296-9191
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 587471053A | Other | MS | BLUE CROSS BLUE SHIELD |
| P00062876 | Other | MS | MEDICARE RAILROAD |
| 03389700 | Medicaid | MS | |
| 670000041 | Other | MS | MEDICARE |
National Provider Directory
National Provider DirectoryLocations
16 Office Park Dr
Ste 21
Hattiesburg, MS 39402
Phone (601) 296-9191
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211932800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1221091200000",
"number": "1396903209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 OFFICE PARK DR",
"address_2": "SUITE 21",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394026020",
"telephone_number": "601-296-9191",
"fax_number": "601-296-9190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 OFFICE PARK DR",
"address_2": "SUITE 21",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394026020",
"telephone_number": "601-296-9191",
"fax_number": "601-296-9190"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SPECIALIZED THERAPY SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-05-28",
"last_updated": "2008-09-11",
"status": "A",
"authorized_official_last_name": "BRUNSON",
"authorized_official_first_name": "MANDY",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "601-296-9191",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT0932",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "MS",
"license": "OT0493",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "587471053A",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00062876",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03389700",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "670000041",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.