MEDICARE: OPTI-HEALTH 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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1942029129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTI-HEALTH LLC

Provider Business Mailing Address
First Line	:	11150 HARRIS LN
Second Line	:
City	:	MAURICE
State	:	LA
Zip	:	70555-3629
Country	:	US
Telephone Number	:	337-344-4977
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 E ETIENNE RD
Second Line	:
City	:	MAURICE
State	:	LA
Zip	:	70555-4375
Country	:	US
Telephone Number	:	337-740-9663
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CORY DON THERIOT
Credential	:	APRN-BC
Telephone Number	:	337-344-4977

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	12/06/2024

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Directions to “OPTI-HEALTH LLC ” Practice Location

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