=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174344360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HESTER WADE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2024
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 NORTH ST
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-304-2448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 W CALIFORNIA AVE APT 204
-----------------------------------------------------
City | RUSTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71270-5469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-376-9283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225800000X
-----------------------------------------------------
Taxonomy Name | Recreation Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------