Healthcare Provider Details

I. General information

NPI: 1851687198
Provider Name (Legal Business Name): PEDIATRIC THERAPY AND LEARNING CENTER OF THE NORTHSHORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 08/12/2025
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 N HWY 190 SUITE 10A
COVINGTON LA
70433-8985
US

IV. Provider business mailing address

2033 N HWY 190 SUITE 10A
COVINGTON LA
70433-8985
US

V. Phone/Fax

Practice location:
  • Phone: 985-590-4549
  • Fax: 985-333-1217
Mailing address:
  • Phone: 985-590-4549
  • Fax: 985-333-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTT.Z12153
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4981
License Number StateLA

VIII. Authorized Official

Name: BRENT ROBERTSON
Title or Position: OWNER
Credential:
Phone: 504-930-4476