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General NPI Number Information
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NPI Number | 1790022762
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Entity Type | Organization
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Legal Business Name | PEDIATRIC NEUROMOTOR CLINIC
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 933 19TH ST S ROOM 115
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City | BIRMINGHAM
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State | AL
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Zip | 35205-3703
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Country | US
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Telephone | 205-975-0466
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Fax | 205-975-2380
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Provider Business Mailing Address
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Address Line | 1720 2ND AVE S CH 19 307
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City | BIRMINGHAM
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State | AL
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Zip | 35294-2041
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Country | US
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Telephone | 205-975-0466
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Fax | 205-975-2380
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY REBEKAH TRUCKS
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Credential | M.S., OTR/L
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Telephone | 205-975-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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