Provider Demographics
NPI:1932411444
Name:CULBERT-WEST, MARY E (OT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CULBERT-WEST
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST SE
Mailing Address - Street 2:STE 200
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:256-350-7757
Practice Address - Street 1:4715 WHITESBURG DR S
Practice Address - Street 2:100
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1632
Practice Address - Country:US
Practice Address - Phone:256-319-8500
Practice Address - Fax:256-319-8503
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALOT0682225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529931220Medicaid
AL1508947839OtherGROUP NPI
ALI392Medicare UPIN