Healthcare Provider Details

I. General information

NPI: 1740666593
Provider Name (Legal Business Name): MARY ELISE DOSS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HUDSON LN STE 7
MONROE LA
71201-6054
US

IV. Provider business mailing address

1300 HUDSON LN STE 7
MONROE LA
71201-6054
US

V. Phone/Fax

Practice location:
  • Phone: 318-361-7180
  • Fax: 318-582-5615
Mailing address:
  • Phone: 318-322-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.200391
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number308761
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: