Healthcare Provider Details

I. General information

NPI: 1164146601
Provider Name (Legal Business Name): SKILL BUILDERS OT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 FORREST AVE
BREWTON AL
36426-2622
US

IV. Provider business mailing address

105 MCMEAD DR
BREWTON AL
36426-1150
US

V. Phone/Fax

Practice location:
  • Phone: 251-241-9454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATALIE JACKSON
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 334-313-2218