Catherine    Brock    OTR
Contract Details
Specialized Therapy Services
Facility name
Provider ID
P000008605
NPI
1841447463
Tax ID
475157490
Effective Date
3/13/2017
Last Updated
3/14/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
911 A Plantation Blvd
Fairhope, AL 36532
United States
County
Baldwin
Phone
2519909082 (Phone)
Billing Details
Address
82 Plantation Pointe
Box 225
Fairhope, AL 36532
Billing Phone
2519909082
Specialty Type
Occupational Medicine
Map
Address