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Amanda
T
Dixon
OTR
Contract Details
Hand and Occupational Therapy Center
Facility name
Provider ID
P000008018
NPI
1083656649
Tax ID
825331488
Effective Date
8/1/2014
Last Updated
8/14/2020
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
2767 Office Park Circle
Montgomery, AL 36116
United States
County
Montgomery
Phone
3342399431
(
Phone
)
Billing Details
Address
2767 Office Park Circle
Montgomery, AL 36116
Billing Phone
3342399431
Specialty Type
Occupational Therapy
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