MEDICARE: LACTATION & DEVELOPMENT RESOURCES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1093469207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACTATION & DEVELOPMENT RESOURCES LLC

Provider Business Mailing Address
First Line	:	6353 SOUTHPOINT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-2107
Country	:	US
Telephone Number	:	214-892-2968
Fax Number	:

Provider Business Practice Location Address
First Line	:	17430 CAMPBELL RD
Second Line	:	ST 107
City	:	DALLAS
State	:	TX
Zip	:	75252-7524
Country	:	US
Telephone Number	:	214-892-2968
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARISSA YAHIL
Credential	:
Telephone Number	:	214-892-2968

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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