Healthcare Provider Details

I. General information

NPI: 1083027601
Provider Name (Legal Business Name): RONALD JENKIE O.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7057 HALCYON SUMMIT DR
MONTGOMERY AL
36117-6927
US

IV. Provider business mailing address

PO BOX 242757
MONTGOMERY AL
36124-2757
US

V. Phone/Fax

Practice location:
  • Phone: 334-625-5809
  • Fax: 334-271-2555
Mailing address:
  • Phone: 334-396-3273
  • Fax: 334-396-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0141
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: