Healthcare Provider Details

I. General information

NPI: 1629560131
Provider Name (Legal Business Name): MAGDALENA CHRISTINE ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 FRENCH ST
NEW ORLEANS LA
70124-3018
US

IV. Provider business mailing address

511 FRENCH ST
NEW ORLEANS LA
70124-3018
US

V. Phone/Fax

Practice location:
  • Phone: 217-390-9373
  • Fax:
Mailing address:
  • Phone: 217-390-9373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number308759
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: