MEDICARE: PEDIATRIC THERAPY AND LEARNING CENTER OF THE NORTHSHORE

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	235Z00000X	Speech-Language Pathologist	4981	LA
2	225XP0200X	Pediatric Occupational Therapist	OTT.Z12153	LA

General Provider Information

NPI Number	:	1851687198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC THERAPY AND LEARNING CENTER OF THE NORTHSHORE

Provider Business Mailing Address
First Line	:	2033 N HWY 190
Second Line	:	SUITE 10A
City	:	COVINGTON
State	:	LA
Zip	:	70433-8985
Country	:	US
Telephone Number	:	985-590-4549
Fax Number	:	985-333-1217

Provider Business Practice Location Address
First Line	:	2033 N HWY 190
Second Line	:	SUITE 10A
City	:	COVINGTON
State	:	LA
Zip	:	70433-8985
Country	:	US
Telephone Number	:	985-590-4549
Fax Number	:	985-333-1217

Authorized Official
Title or Position	:	OWNER
Name	:	BRENT ROBERTSON
Credential	:
Telephone Number	:	504-930-4476

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	08/12/2025

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Directions to “PEDIATRIC THERAPY AND LEARNING CENTER OF THE NORTHSHORE ” Practice Location

Language	Start Address	Practice Location

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