Provider Demographics
NPI:1336353036
Name:JLT THERAPEUTIC SERVICES,INC.
Entity Type:Organization
Organization Name:JLT THERAPEUTIC SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-669-7455
Mailing Address - Street 1:4863 HUTSON AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35207-1215
Mailing Address - Country:US
Mailing Address - Phone:205-669-7455
Mailing Address - Fax:205-328-5821
Practice Address - Street 1:4863 HUTSON AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-1215
Practice Address - Country:US
Practice Address - Phone:205-669-7455
Practice Address - Fax:205-328-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0050225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty