MEDICARE: INTEGRATIVE TOUCH PEDIATRIC OCCUPATIONAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA.Z20645	LA

General Provider Information

NPI Number	:	1316114218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE TOUCH PEDIATRIC OCCUPATIONAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	4899 WESTBANK EXPY
Second Line	:	SUITE D
City	:	MARRERO
State	:	LA
Zip	:	70072-3037
Country	:	US
Telephone Number	:	504-494-8339
Fax Number	:

Provider Business Practice Location Address
First Line	:	4899 WESTBANK EXPY
Second Line	:	SUITE D
City	:	MARRERO
State	:	LA
Zip	:	70072-3037
Country	:	US
Telephone Number	:	504-494-8339
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JO ANN P PUGLISE
Credential	:	COTA
Telephone Number	:	504-494-8339

Provider Enumeration Date	:	05/11/2008
Last Update Date	:	05/11/2008

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