Healthcare Provider Details

I. General information

NPI: 1780907535
Provider Name (Legal Business Name): ROBERT TRAHAN L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 07/09/2022
Certification Date: 07/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12338 NORTHWOOD XING
HAMMOND LA
70401-6014
US

IV. Provider business mailing address

12338 NORTHWOOD XING
HAMMOND LA
70401-6014
US

V. Phone/Fax

Practice location:
  • Phone: 985-902-8587
  • Fax:
Mailing address:
  • Phone: 985-969-5039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberOTT.Z11771
License Number StateLA

VIII. Authorized Official

Name: MR. ROBERT TRAHAN
Title or Position: OWNER
Credential:
Phone: 985-969-5039