Provider Demographics
NPI:1841897535
Name:SPIKES, AUDREY ANNA (OT)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANNA
Last Name:SPIKES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:100 N FLORIDA ST STE 31
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3010
Practice Address - Country:US
Practice Address - Phone:251-300-8874
Practice Address - Fax:251-308-3126
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5253225X00000X
MSOT-3830225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist