Healthcare Provider Details

I. General information

NPI: 1780778340
Provider Name (Legal Business Name): NORTHSHORE THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 EAST GAUSE BOULEVARD SUITE 2
SLIDELL LA
70461
US

IV. Provider business mailing address

2790 EAST GAUSE BOULEVARD SUITE 2
SLIDELL LA
70461
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-6880
  • Fax: 985-643-8104
Mailing address:
  • Phone: 985-643-6880
  • Fax: 985-643-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.200062
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTT.200062
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOTT.200062
License Number StateLA

VIII. Authorized Official

Name: MRS. AMANDA VARNADO MILLER
Title or Position: PRESIDENT
Credential: MOT, LOTR
Phone: 985-643-6880