Healthcare Provider Details

I. General information

NPI: 1750063061
Provider Name (Legal Business Name): WELLSPRING THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5329 DIJON DR STE 103
BATON ROUGE LA
70808-4378
US

IV. Provider business mailing address

316 HIGHLAND TRACE DR
BATON ROUGE LA
70810-5059
US

V. Phone/Fax

Practice location:
  • Phone: 225-250-5461
  • Fax:
Mailing address:
  • Phone: 310-428-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHEL CHAUVIN
Title or Position: OWNER, THERAPIST
Credential: OT
Phone: 225-250-5461