=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447448550
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDIATRIC THERAPY LINK OF NORTH ALABAMA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2007
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8331 MADISON BLVD STE 300
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-883-7338
-----------------------------------------------------
Fax | 256-883-7135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8331 MADISON BLVD STE 300
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-883-7338
-----------------------------------------------------
Fax | 256-883-7135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MS. MARY THERESE MAYHAN
-----------------------------------------------------
Credential | MS, OTRL
-----------------------------------------------------
Telephone | 256-883-7338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 2306
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------