MEDICARE: T.E.A.M. FOR KIDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist
2	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1275232811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T.E.A.M. FOR KIDS, LLC

Provider Business Mailing Address
First Line	:	320 SNOW ST STE A
Second Line	:
City	:	OXFORD
State	:	AL
Zip	:	36203-5402
Country	:	US
Telephone Number	:	256-770-5009
Fax Number	:	844-592-2568

Provider Business Practice Location Address
First Line	:	320 SNOW ST STE A
Second Line	:
City	:	OXFORD
State	:	AL
Zip	:	36203-5402
Country	:	US
Telephone Number	:	256-770-5009
Fax Number	:	844-592-2568

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AUTUMN MICHELLE BOBO
Credential	:	OTR/L
Telephone Number	:	256-310-8053

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	10/01/2024

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Language	Start Address	Practice Location

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