Healthcare Provider Details

I. General information

NPI: 1275232811
Provider Name (Legal Business Name): T.E.A.M. FOR KIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SNOW ST STE A
OXFORD AL
36203-5402
US

IV. Provider business mailing address

320 SNOW ST STE A
OXFORD AL
36203-5402
US

V. Phone/Fax

Practice location:
  • Phone: 256-770-5009
  • Fax: 844-592-2568
Mailing address:
  • Phone: 256-770-5009
  • Fax: 844-592-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AUTUMN MICHELLE BOBO
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 256-310-8053