Organization · NPI-2

1720 Pediatric Therapy

Occupational Therapist, Pediatrics · Lafayette, LA

NPI number1770314403
StatusActive
Last updated in NPPESDec 17, 2024

Details

NPI
1770314403
Entity type
Organization (NPI-2)
Legal business name
1720 Pediatric Therapy
Organization subpart
No
Enumeration date
Aug 13, 2024
Certification date
Dec 17, 2024
Last updated
Dec 17, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225XP0200X Occupational Therapist, Pediatrics––Yes
261QD1600X Clinic/Center, Developmental Disabilities––

Practice location

120 Muscadine Lane
Lafayette, LA 70508

Phone 214-729-6560

Mailing address

120 Muscadine Lane
Lafayette, LA 70508

Phone 214-729-6560

Authorized official

Seth Hilburn
Owner-Occupational Therapist
2147296560

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