Healthcare Provider Details

I. General information

NPI: 1619117637
Provider Name (Legal Business Name): PUZZLE PIECE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 CAHABA HEIGHTS RD STE 102
VESTAVIA AL
35243-5243
US

IV. Provider business mailing address

3140 CAHABA HEIGHTS RD STE 102
VESTAVIA AL
35243-5243
US

V. Phone/Fax

Practice location:
  • Phone: 205-969-8080
  • Fax: 205-969-4884
Mailing address:
  • Phone: 205-969-8080
  • Fax: 205-969-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1822
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: RENEE PLATA
Title or Position: OWNER
Credential:
Phone: 205-969-8080