Dorothy Michele Fulgham, O.T.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT1622 Issued in MS

Practice address

130 Parkway PLZ
Kosciusko, MS 39090-3217

Phone

(662) 289-3588

Fax

(662) 289-2486

NPI assigned

Apr 11, 2006

Last updated

Apr 8, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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 LLCGroup PAC ID 8729973623, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Premier Medical Group of Mississippi LLC

  dba Kosciusko Medical Clinic

  • Clinic/Center
  • Kosciusko, MS
  • NPI 1790827038
  Medicare reassignment Care Compare group NPD
• Premier Medical Group of Mississippi LLC

  dba Jackson Medical Clinic LLC

  • Clinic/Center
  • Jackson, MS
  • NPI 1548219884
  NPD (past)

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365379200000",
    "number": "1497718399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23996",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253996",
            "telephone_number": "601-206-6100",
            "fax_number": "601-206-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 PARKWAY PLZ",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903217",
            "telephone_number": "662-289-3588",
            "fax_number": "662-289-2486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULGHAM",
        "first_name": "DOROTHY",
        "middle_name": "MICHELE",
        "name_prefix": "Mrs.",
        "credential": "O.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2013-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT1622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Barnett Ferguson, FNP-C
• Imani Finley, OT
• Memorie Finnie
• Courtney Fletcher, M.S.,SLP
• Mary Fox, NURSE PRACTITIONER
• Diana Fuller,Micou
• Robert Kirtis Greenlee, FNP
• Anita Greer
• Detric Griffin
• Emily Cook Gross

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.