Healthcare Provider Details

I. General information

NPI: 1427561141
Provider Name (Legal Business Name): MARK - MEANINGFUL AUTISTIC RESOURCES FOR KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41172 NEW ORLEANS DR
SORRENTO LA
70778-3424
US

IV. Provider business mailing address

41172 NEW ORLEANS DR
SORRENTO LA
70778-3424
US

V. Phone/Fax

Practice location:
  • Phone: 225-892-9570
  • Fax:
Mailing address:
  • Phone: 225-892-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA ROQUEMORE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 225-892-9570