Provider Demographics
NPI:1629876008
Name:JONES, RAVEN RENEE (OTR/L)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:RENEE
Last Name:JONES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HEIDELBERG
Mailing Address - State:MS
Mailing Address - Zip Code:39439-3327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1417 LELIA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4721
Practice Address - Country:US
Practice Address - Phone:601-345-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4152225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist