Healthcare Provider Details

I. General information

NPI: 1295959401
Provider Name (Legal Business Name): JOHN SCOTT HIDALGO OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 I 49 S SERVICE RD
OPELOUSAS LA
70570-0757
US

IV. Provider business mailing address

420 W PINHOOK RD SUITE A
LAFAYETTE LA
70503-2131
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-4212
  • Fax: 337-942-9979
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-942-9979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ11534
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: