Healthcare Provider Details

I. General information

NPI: 1265898001
Provider Name (Legal Business Name): ALABAMA PEDIATRIC THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2016
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 6TH ST S
ONEONTA AL
35121-1828
US

IV. Provider business mailing address

315 6TH ST S
ONEONTA AL
35121-1828
US

V. Phone/Fax

Practice location:
  • Phone: 256-504-6097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3971
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3700
License Number StateAL

VIII. Authorized Official

Name: KATIE NEAL
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: M.S., OTR/L
Phone: 256-504-6097