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NPI Code Detail

MEDICARE: GREEN GABLES THERAPY LLC

MEDICARE: GREEN GABLES 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
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1639744576
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREEN GABLES THERAPY LLC
Provider Business Mailing Address
First Line : 5445 HIGHWAY 2
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-8365
Country : US
Telephone Number : 318-488-0893
Fax Number :
Provider Business Practice Location Address
First Line : 5445 HIGHWAY 2
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-8365
Country : US
Telephone Number : 318-488-0893
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : HEATHER L MADDEN
Credential : OT
Telephone Number : 318-488-0893
Provider Enumeration Date : 05/24/2021
Last Update Date : 05/24/2021

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Directions to “GREEN GABLES THERAPY LLC ” Practice Location

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