Cynthia  G  Powell    OTR
Contract Details
Gulf Coast Therapy
Facility name
Provider ID
P000008555
NPI
1588678296
Tax ID
631057933
Effective Date
1/19/2017
Last Updated
10/22/2019
Direct Contract
Yes
Term Date
10/8/2019
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
9890 Twin Beech Rd.
Fairhope, AL 36532
United States
County
Baldwin
Phone
2514760525 (Phone)
Billing Details
Address
9890 Twin Beech Rd.
Fairhope, AL 36532
Billing Phone
2514760525
Specialty Type
Occupational Therapy
Map
Address