Active NPI
Myranda Lancaster
- Occupational Therapist
- Water Valley, MS
National Provider Identifier
1639727134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT3702
- Practice address
- 630 S Main St
Water Valley, MS 38965-3468 - Phone
- (662) 473-5947
- Fax
- (601) 607-1416
- NPI assigned
- Aug 28, 2019
- Last updated
- Aug 28, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT3702 | MS | Primary |
Addresses
Primary practice location
630 S Main St
Water Valley, MS 38965-3468
Mailing address
711 Avignon Dr
Ridgeland, MS 39157-5120
Phone (601) 605-6777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT3702 | MS | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566950400000",
"number": "1639727134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 AVIGNON DR",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391575120",
"telephone_number": "601-605-6777",
"fax_number": "601-607-1362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 S MAIN ST",
"city": "WATER VALLEY",
"state": "MS",
"postal_code": "389653468",
"telephone_number": "662-473-5947",
"fax_number": "601-607-1416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANCASTER",
"first_name": "MYRANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-28",
"last_updated": "2019-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MS",
"license": "OT3702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Water Valley, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.