Healthcare Provider Details

I. General information

NPI: 1073968020
Provider Name (Legal Business Name): JASON EUGENE VICE OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 UNIVERSITY BLVD SUITE 405
BIRMINGHAM AL
35233-1816
US

IV. Provider business mailing address

P.O. BOX 830941, MSC 559
BIRMINGHAM AL
35283
US

V. Phone/Fax

Practice location:
  • Phone: 205-488-0736
  • Fax: 205-488-0746
Mailing address:
  • Phone: 205-325-8536
  • Fax: 205-325-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4153
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: