NPIMap

Individual provider Active NPI

Marjorie Elizabeth Iles, OT

  • Occupational Therapist
  • Vicksburg, MS
National Provider Identifier
1972782639
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT2114 Issued in MS
Practice address
1901 Mission 66
Suite a
Vicksburg, MS 39180-3711
Phone
(601) 638-4076
Fax
(601) 883-2232
NPI assigned
Oct 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT2114 MS Primary

Addresses

Primary practice location

1901 Mission 66
Suite a
Vicksburg, MS 39180-3711

Mailing address

PO Box 822394
Vicksburg, MS 39182-2394
Phone (601) 638-4076

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

LicenseStateTypeSpecialty
OT2114MSMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Physical Therapy,Inc. Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193702400000",
    "number": "1972782639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 822394",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391822394",
            "telephone_number": "601-638-4076",
            "fax_number": "601-883-2232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 MISSION 66",
            "address_2": "SUITE A",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803711",
            "telephone_number": "601-638-4076",
            "fax_number": "601-883-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILES",
        "first_name": "MARJORIE",
        "middle_name": "ELIZABETH",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-30",
        "last_updated": "2007-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT2114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.

Verify at the official NPI Registry.