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General NPI Number Information
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NPI Number | 1003148487
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Entity Type | Individual
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Provider Name | KELLY RAWLS FOUNTAIN M.S., L.P.T.
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Gender | Female
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Dates
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Enumeration Date | 02/09/2010
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 2864 DAUPHIN ST SUITE A
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City | MOBILE
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State | AL
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Zip | 36606-2479
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Country | US
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Telephone | 251-470-7607
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Fax | 251-470-7609
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Provider Business Mailing Address
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Address Line | 2864 DAUPHIN ST SUITE A
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City | MOBILE
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State | AL
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Zip | 36606-2479
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Country | US
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Telephone | 251-470-7607
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Fax | 251-470-7609
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1586
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License Number State | AL
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