Basic Information
| Provider Information | |||||||||
| NPI: | 1871659045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIGGINBOTHAM | ||||||||
| FirstName: | RODNEY | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HIGGINBOTHAM | ||||||||
| OtherFirstName: | R. | ||||||||
| OtherMiddleName: | J. | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O.T. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5804 GREENBRIAR LOOP | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355036734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052217953 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4330 HIGHWAY 78 E | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | JASPER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355018905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052952434 | ||||||||
| FaxNumber: | 2053846117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2193 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2193 | 01 | AL | OT LICENSE | OTHER |