Provider Demographics
NPI:1023321254
Name:TAPPA, GEORGIANNA (COTA-L)
Entity type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:
Last Name:TAPPA
Suffix:
Gender:F
Credentials:COTA-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 NORTHWEST AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:MS
Mailing Address - Zip Code:39063-3009
Mailing Address - Country:US
Mailing Address - Phone:601-624-0116
Mailing Address - Fax:662-464-7700
Practice Address - Street 1:868 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:VAIDEN
Practice Address - State:MS
Practice Address - Zip Code:39176-5385
Practice Address - Country:US
Practice Address - Phone:662-464-7714
Practice Address - Fax:662-464-7700
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA0126224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant