Healthcare Provider Details

I. General information

NPI: 1750153987
Provider Name (Legal Business Name): GRACE CIRCLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 CARMICHAEL RD
MONTGOMERY AL
36106-3601
US

IV. Provider business mailing address

4209 CARMICHAEL RD
MONTGOMERY AL
36106-3601
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-1020
  • Fax: 334-356-2177
Mailing address:
  • Phone: 334-356-1020
  • Fax: 334-356-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA R GIBSON
Title or Position: OCCUPATIONAL THERAPIST
Credential: M.S. OTR/L
Phone: 334-590-0164