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General NPI Number Information
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NPI Number | 1003252008
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Entity Type | Organization
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Legal Business Name | ST NICHOLAS PEDIATRIC EVAUATIONS AND THERAPY SERVICES LLC
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 109 CONSTELLATION DR
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City | SLIDELL
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State | LA
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Zip | 70458-9029
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Country | US
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Telephone | 985-502-8853
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Fax | 985-288-4572
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Provider Business Mailing Address
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Address Line | 109 CONSTELLATION DR
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City | SLIDELL
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State | LA
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Zip | 70458-9029
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Country | US
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Telephone | 985-502-8853
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Fax | 985-288-4572
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/ OWNER
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Name | MRS. LISA R HESSON
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Credential | OTR/L
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Telephone | 985-502-8853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT1528
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT1528
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License Number State | MS
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