MEDICARE: OVER THE MOUNTAIN SPEECH, LANGUAGE, AND LEARNING SERVICES, 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	922	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	510-00707	OTHER	AL	BLUECROSS/BLUESHIELD PROV
2	510-01141	OTHER	AL	BLUECROSS/BLUESHIELD PROV
3	515-33411	OTHER	AL	BLUECROSS/BLUESHIELD PROV
4	515-33731	OTHER	AL	BLUECROSS/BLUESHIELD PROV
5	515-29582	OTHER	AL	BLUECROSS/BLUESHIELD PROV
6	515-31438	OTHER	AL	BLUECROSS/BLUESHIELD PROV
7	515-26698	OTHER	AL	BLUECROSS/BLUESHIELD PROV
8	515-30480	OTHER	AL	BLUECROSS/BLUESHIELD PROV
9	515-30858	OTHER	AL	BLUECROSS/BLUESHIELD PROV
10	515-30645	OTHER	AL	BLUECROSS/BLUESHIELD PROV
11	510-01381	OTHER	AL	BLUECROSS/BLUESHIELD PROV
12	515-29574	OTHER	AL	BLUECROSS/BLUESHIELD PROV
13	515-33809	OTHER	AL	BLUECROSS/BLUESHIELD PROV
14	510-00761	OTHER	AL	BLUECROSS/BLUESHIELD PROV
15	515-29553	OTHER	AL	BLUECROSS/BLUESHIELD PROV
16	515-34168	OTHER	AL	BLUECROSS/BLUESHIELD PROV

General Provider Information

NPI Number	:	1588754808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVER THE MOUNTAIN SPEECH, LANGUAGE, AND LEARNING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1050 LAKE COLONY LN
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35242-7405
Country	:	US
Telephone Number	:	205-531-8998
Fax Number	:	205-970-4122

Provider Business Practice Location Address
First Line	:	4231 DOLLY RIDGE ROAD
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35243
Country	:	US
Telephone Number	:	205-531-8998
Fax Number	:	205-970-4122

Authorized Official
Title or Position	:	SPEECH/LANGUAGE PATHOLOGIST
Name	:	MRS. JERRI HENDRIX SMITH
Credential	:	MCD, CCC-SLP
Telephone Number	:	205-531-8998

Provider Enumeration Date	:	10/15/2006
Last Update Date	:	09/12/2012

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