Provider Demographics
NPI:1447448550
Name:PEDIATRIC THERAPY LINK OF NORTH ALABAMA, LLC
Entity type:Organization
Organization Name:PEDIATRIC THERAPY LINK OF NORTH ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:MAYHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTRL
Authorized Official - Phone:256-883-7338
Mailing Address - Street 1:8331 MADISON BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2073
Mailing Address - Country:US
Mailing Address - Phone:256-883-7338
Mailing Address - Fax:256-883-7135
Practice Address - Street 1:8331 MADISON BLVD
Practice Address - Street 2:STE 300
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2073
Practice Address - Country:US
Practice Address - Phone:256-883-7338
Practice Address - Fax:256-883-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2306261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51523367OtherBCBSAL
AL125125Medicaid
AL51523367OtherBLUE CROSS BLUE SHIELD