Provider Demographics
NPI:1447595236
Name:SUMMERFORD, JAIME L (COTA)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:SUMMERFORD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LOGAN LN SW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-3740
Mailing Address - Country:US
Mailing Address - Phone:256-221-1342
Mailing Address - Fax:
Practice Address - Street 1:500 LOGAN LN SW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-3740
Practice Address - Country:US
Practice Address - Phone:256-221-1342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3229224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant