Provider Demographics
NPI:1972795656
Name:STEELE, MARK ALLEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:STEELE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 CAHABA VALLEY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2216
Mailing Address - Country:US
Mailing Address - Phone:205-616-8738
Mailing Address - Fax:
Practice Address - Street 1:183 FENNELL ST
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-3109
Practice Address - Country:US
Practice Address - Phone:205-616-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2567224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant