Individual
ELYSE DICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2823 GREYSTONE COMMERCIAL BLVD, BIRMINGHAM, AL 35242-2660
(205) 745-3660
Mailing address
2823 GREYSTONE COMMERCIAL BLVD, BIRMINGHAM, AL 35242-2660
(205) 745-3660
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4678
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4678
LICENSE
AL
Enumeration date
07/15/2019
Last updated
07/15/2019
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