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NPI Code Detail

MEDICARE: MARY CERISE ROPER OT, CHT

MEDICARE: MARY CERISE ROPER OT, CHT
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
1225XH1200XHand Occupational TherapistZ10559LA

General Provider Information

NPI Number : 1689839516
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CERISE ROPER OT, CHT
Provider Business Mailing Address
First Line : 274 HIGHWAY 789
Second Line :
City : KEATCHIE
State : LA
Zip : 71046-4900
Country : US
Telephone Number : 318-933-0077
Fax Number :
Provider Business Practice Location Address
First Line : 2906 PLANTATION DR
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-5851
Country : US
Telephone Number : 318-746-5295
Fax Number : 318-746-5297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2008
Last Update Date : 03/30/2009

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