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General NPI Number Information
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NPI Number | 1942029129
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Entity Type | Organization
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Legal Business Name | OPTI-HEALTH LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 213 E ETIENNE RD
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City | MAURICE
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State | LA
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Zip | 70555-4375
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Country | US
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Telephone | 337-740-9663
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Fax |
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Provider Business Mailing Address
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Address Line | 11150 HARRIS LN
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City | MAURICE
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State | LA
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Zip | 70555-3629
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Country | US
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Telephone | 337-344-4977
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CORY DON THERIOT
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Credential | APRN-BC
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Telephone | 337-344-4977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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