Dorothy Michele Fulgham, O.T.
Individual provider Active NPI Occupational Therapist · Kosciusko, MS
NPI 1497718399 · NPPES record last updated Apr 8, 2013
Key facts
- NPI
- 1497718399
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT1622 (MS)
- Practice address
- 130 Parkway PLZ
Kosciusko, MS 39090-3217 - Phone
- (662) 289-3588
- Fax
- (662) 289-2486
- NPI assigned
- Apr 11, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Premier Medical Group of Mississippi LLC
Practice addresses (Care Compare)
332 Hwy 12 W
Kosciusko, MS 39090-3209
Phone (662) 289-1800
340 Hwy 12 W
Kosciusko, MS 39090-3209
Phone (662) 289-3588
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050222000487 | MS | Practitioner - Occupational Therapist in Private Practice | 8527011386 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT1622 | MS | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Medical Group of Mississippi LLC | Current |
Accepting new patients | |
| Premier Medical Group of Mississippi LLC | Past | Accepting new patients |
Locations
130 Parkway Plz
Kosciusko, MS 39090
Phone (662) 289-3588
332 Highway 12 W
Kosciusko, MS 39090
Phone (601) 206-6100
340 Highway 12 W
Kosciusko, MS 39090
Phone (662) 289-1551
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT1622 | MS | Yes |
Addresses
Primary practice location
130 Parkway PLZ
Kosciusko, MS 39090-3217
Mailing address
PO Box 23996
Jackson, MS 39225-3996
Phone (601) 206-6100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00273305 | Medicaid | MS |
Other providers in Kosciusko, MS
- Kayla Barnett Ferguson
- Imani Finley
- Memorie Finnie
- Courtney Fletcher
- Mary Fox
- Diana Fuller,Micou
- Robert Kirtis Greenlee
- Anita Greer
- Detric Griffin
- Emily Cook Gross
All providers in Kosciusko, 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 Apr 8, 2013. 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.