Provider Demographics
NPI:1598866998
Name:VAUGHAN, THERA VIRGINIA (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:THERA
Middle Name:VIRGINIA
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HIGHLAND AVE S
Mailing Address - Street 2:APARTMENT F6
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2458
Mailing Address - Country:US
Mailing Address - Phone:205-328-4480
Mailing Address - Fax:
Practice Address - Street 1:245 CAHABA VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2216
Practice Address - Country:US
Practice Address - Phone:205-942-6820
Practice Address - Fax:205-942-5627
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist