Active NPI
Micki Jo Deer
- Occupational Therapist
- McComb, MS
National Provider Identifier
1912194002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2109
- Practice address
- 206 Maryland Ave
McComb, MS 39648-3926 - Phone
- (601) 250-4815
- NPI assigned
- Oct 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 2109 | MS | Primary |
Addresses
Primary practice location
206 Maryland Ave
McComb, MS 39648-3926
Mailing address
3062 Highway 44 E
McComb, MS 39648-8508
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 |
|---|---|---|---|
| 2109 | MS | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191283200000",
"number": "1912194002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3062 HIGHWAY 44 E",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396488508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 MARYLAND AVE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "396483926",
"telephone_number": "601-250-4815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEER",
"first_name": "MICKI",
"middle_name": "JO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-02",
"last_updated": "2007-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MS",
"license": "2109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McComb, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.