Provider Demographics
NPI:1487700837
Name:FOSTER, JEFFREY S (MS, OTR/L)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-9339
Mailing Address - Country:US
Mailing Address - Phone:601-672-8816
Mailing Address - Fax:
Practice Address - Street 1:557 FIRST ST
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:MS
Practice Address - Zip Code:39071-9339
Practice Address - Country:US
Practice Address - Phone:601-672-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02131059Medicaid
MS02131059Medicaid
MSQ00546Medicare UPIN