Healthcare Provider Details

I. General information

NPI: 1962365833
Provider Name (Legal Business Name): DYMON MARKAYLA BARROW RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 JEFFERSON HWY
JEFFERSON LA
70121-3828
US

IV. Provider business mailing address

4456 PONTCHARTRAIN DR
SLIDELL LA
70458-8527
US

V. Phone/Fax

Practice location:
  • Phone: 504-291-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: