Healthcare Provider Details

I. General information

NPI: 1871165134
Provider Name (Legal Business Name): MRS. REBECCA CARTER TISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 CENTER ST STE B
MOBILE AL
36604-1543
US

IV. Provider business mailing address

PO BOX 746450
ATLANTA GA
30374-6450
US

V. Phone/Fax

Practice location:
  • Phone: 251-415-1670
  • Fax: 251-415-1671
Mailing address:
  • Phone: 251-434-3626
  • Fax: 251-445-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3957
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: