Fairuza Zan Trust

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

FAIRUZA ZAN TRUST

Practice address

6569 Highway 305 N
Olive Branch, MS 38654-3044

Phone

(901) 870-1246

NPI assigned

Apr 29, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Iris Gray, OTR/LNPI 1578741807

Title

Ceo

Phone

(901) 870-1246

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Locations

Practitioners 1

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

• Iris Gray, BSOT

  • Occupational Therapist
  • Olive Branch, MS
  • NPI 1578741807
  NPD Authorized official

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

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1508449372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6569 HIGHWAY 305 N",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543044",
            "telephone_number": "901-870-1246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6569 HIGHWAY 305 N",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543044",
            "telephone_number": "901-870-1246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRUZA ZAN TRUST",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-29",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "IRIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-870-1246",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01820347",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Scanner/fax",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4245 Sunset Rd",
            "city": "Nesbit",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386519015",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "fzantrust@gmail.com",
            "affiliation": "N",
            "address_1": "6569 Highway 305 N",
            "city": "Olive Branch",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386543044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Amanda Ferguson, SLP
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• Early Intervention Provider Agency in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Early Intervention Provider Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.