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NPI Code Detail

MEDICARE: EBONEE CRAIGHEAD

MEDICARE: EBONEE CRAIGHEAD
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
1222Q00000XDevelopmental Therapist
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1801293071
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONEE CRAIGHEAD
Provider Business Mailing Address
First Line : 327 SOUTH EMILE
Second Line :
City : GARYVILLE
State : LA
Zip : 70051
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 327 SOUTH EMILE ST
Second Line :
City : GARYVILLE
State : LA
Zip : 70051
Country : US
Telephone Number : 504-939-7693
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2014
Last Update Date : 02/26/2019

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Directions to “ EBONEE CRAIGHEAD ” Practice Location

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