Healthcare Provider Details

I. General information

NPI: 1285867143
Provider Name (Legal Business Name): MICHELLE PUCKETT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S PT/OT, SUITE 4NW
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1600 7TH AVE S PT/OT, SUITE 4NW
BIRMINGHAM AL
35233-1711
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-9645
  • Fax: 205-939-6067
Mailing address:
  • Phone: 205-939-9645
  • Fax: 205-939-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2508
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: