Healthcare Provider Details

I. General information

NPI: 1083537641
Provider Name (Legal Business Name): KALYN SUZANNE BAZELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CAUSEWAY APPROACH STE 108
MANDEVILLE LA
70471-2971
US

IV. Provider business mailing address

10088 CHANEL DR
DENHAM SPRINGS LA
70706-2043
US

V. Phone/Fax

Practice location:
  • Phone: 225-503-5336
  • Fax:
Mailing address:
  • Phone: 225-503-5336
  • Fax: 318-608-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA10513
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: