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Organization

PEDIATRIC NEUROMOTOR CLINIC

Active
Parent organization
SPARKS CLINIC
Organization subpart
Yes

Provider details

NPI number
Legal business name
SPARKS CLINIC
Authorized official
MARY REBEKAH TRUCKS M.S., OTR/L (DIRECTOR)
(205) 975-0466
Entity
Organization

Contact information

Practice address
933 19TH ST S, ROOM 115, BIRMINGHAM, AL 35205-3703
(205) 975-0466
(205) 975-2380
Mailing address
1720 2ND AVE S, CH 19 307, BIRMINGHAM, AL 35294-2041
(205) 975-0466
(205) 975-2380

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary

Other

Enumeration date
01/11/2013
Last updated
01/11/2013
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