# PROSPEROUS LIVING LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336548783
- **Authorized official:** STACIE JACKSON OTR/L (OCCUPATIONAL THERAPIST/PRESIDENT)
- **Authorized official phone:** (205) 266-5394

## Contact information

- **Practice address:** 1974 CHANDALAR DR, SUITE D, PELHAM, AL 35124-4340
- **Practice address phone:** (205) 358-3515
- **Mailing address:** 719 HERITAGE PARK LN, HOOVER, AL 35226-4198
- **Mailing address phone:** (205) 266-5394
- **Mailing address fax:** (205) 358-3517

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | 2276 | AL | Yes |
| 225XG0600X | Gerontology Occupational Therapist | 2276 | AL | — |
| 225XL0004X | Low Vision Occupational Therapist | 2276 | AL | — |

## Other

- **Enumeration date:** 08/21/2014
- **Last updated:** 08/21/2014