Functional Therapy Center, Inc.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

FUNCTIONAL THERAPY CENTER, INC.

Practice address

499 Gloster Creek VLG
Suite I-3
Tupelo, MS 38801-4600

Phone

(662) 844-4471

Fax

(662) 844-4472

NPI assigned

Oct 31, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Nikolas Doyle Carnathan, OTR/LNPI 1437140415

Title

President

Phone

(662) 844-4471

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nikolas Doyle Carnathan, OTR/L

  • Occupational Therapist
  • Tupelo, MS
  • NPI 1437140415
  NPD (past) Authorized official

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407847478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG",
            "address_2": "SUITE I-3",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014600",
            "telephone_number": "662-844-4471",
            "fax_number": "662-844-4472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG",
            "address_2": "SUITE I-3",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014600",
            "telephone_number": "662-844-4471",
            "fax_number": "662-844-4472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL THERAPY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARNATHAN",
        "authorized_official_first_name": "NIKOLAS",
        "authorized_official_middle_name": "DOYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-844-4471",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00304504",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Frost
• Jordan Danielle Fugett
• Leslie Fugett, LMSW
• Relda Fugitt
• Joshua Campbell Fulwiler, PHD
• Mary Gadus, FNP
• Shelley A Gaggini, DIETITIAN
• Kendal Gaines
• Christian Gallo Rios, RBT
• Brian Joseph Galloway, LPC

• Occupational Therapist in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Occupational Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.