Healthcare Provider Details

I. General information

NPI: 1518876184
Provider Name (Legal Business Name): RICHELLE DESLATTE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 WAVERLY ST
METAIRIE LA
70006-5418
US

IV. Provider business mailing address

4310 WAVERLY ST
METAIRIE LA
70006-5418
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9557
  • Fax:
Mailing address:
  • Phone: 504-896-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number335709
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: