Provider Demographics
NPI:1548449762
Name:MIMS, RASHIDA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:RASHIDA
Middle Name:
Last Name:MIMS
Suffix:
Gender:F
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 1:755 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0625
Mailing Address - Country:US
Mailing Address - Phone:478-296-9725
Mailing Address - Fax:
Practice Address - Street 1:106 CORPORATE SQ STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4255
Practice Address - Country:US
Practice Address - Phone:478-275-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist