Healthcare Provider Details

I. General information

NPI: 1669551859
Provider Name (Legal Business Name): ANNE ELIZABETH PRATKA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S JEFFERSON ST
ABBEVILLE LA
70510-5906
US

IV. Provider business mailing address

917 KIM DR
LAFAYETTE LA
70503-4025
US

V. Phone/Fax

Practice location:
  • Phone: 337-893-2899
  • Fax: 337-898-5816
Mailing address:
  • Phone: 337-989-8598
  • Fax: 337-989-8598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ10043
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: