Healthcare Provider Details

I. General information

NPI: 1245720002
Provider Name (Legal Business Name): DELTA REHAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7956 VAUGHN RD STE 202
MONTGOMERY AL
36116-6625
US

IV. Provider business mailing address

7956 VAUGHN RD STE 202
MONTGOMERY AL
36116-6625
US

V. Phone/Fax

Practice location:
  • Phone: 334-392-9214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY NACOLE JORDAN
Title or Position: CEO/OCCUPATIONAL THERAPIST
Credential: OTD, MSOT, OTR/L
Phone: 334-392-9214