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General NPI Number Information
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NPI Number | 1639347453
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Entity Type | Individual
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Provider Name | MARY FORMBY OTR
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Gender | Female
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 400 PAUL BRYANT DRIVE E
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City | TUSCALOOSA
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State | AL
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Zip | 35401-2009
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Country | US
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Telephone | 205-345-0192
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Fax | 205-247-2194
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Provider Business Mailing Address
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Address Line | 305 PAUL BRYANT DRIVE E
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City | TUSCALOOSA
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State | AL
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Zip | 35401-2055
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Country | US
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Telephone | 205-345-0192
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Fax | 205-247-2194
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 02501
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 2717
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License Number State | AL
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