Healthcare Provider Details

I. General information

NPI: 1447020284
Provider Name (Legal Business Name): TRIPPEL INTERESTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6799 E TEXAS ST
BOSSIER CITY LA
71111
US

IV. Provider business mailing address

6799 E TEXAS ST
BOSSIER CITY LA
71111
US

V. Phone/Fax

Practice location:
  • Phone: 318-616-2336
  • Fax:
Mailing address:
  • Phone: 318-616-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MADELYN MARIE TRIPPEL
Title or Position: OCCUPATIONAL THERAPIST
Credential: LOTR
Phone: 318-616-2336