=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861355786
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TALKING TIDES THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21443 ROUNDHOUSE RD
-----------------------------------------------------
City | FAIRHOPE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36532-5172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-454-2439
-----------------------------------------------------
Fax | 251-929-9836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21443 ROUNDHOUSE RD
-----------------------------------------------------
City | FAIRHOPE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36532-5172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-454-2439
-----------------------------------------------------
Fax | 251-929-9836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. KATHRYN LANE DAVIDSON
-----------------------------------------------------
Credential | M.S., CCC-SLP
-----------------------------------------------------
Telephone | 601-454-2439
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------