Healthcare Provider Details

I. General information

NPI: 1790807113
Provider Name (Legal Business Name): MARIA ANNE HOTARD STELLY MED, CCC, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 HOTARD DR
RESERVE LA
70084-6009
US

IV. Provider business mailing address

261 HOTARD DR
RESERVE LA
70084-6009
US

V. Phone/Fax

Practice location:
  • Phone: 985-536-7441
  • Fax:
Mailing address:
  • Phone: 985-536-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3427
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: