Provider Demographics
NPI:1104975192
Name:ANDERSON, NATYLON NICOLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NATYLON
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:NATYLON
Other - Middle Name:NICOLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1503 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6133
Mailing Address - Country:US
Mailing Address - Phone:662-842-4320
Mailing Address - Fax:
Practice Address - Street 1:711 AVIGNON DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5120
Practice Address - Country:US
Practice Address - Phone:601-605-6777
Practice Address - Fax:601-605-8869
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1926225XE0001X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification