MEDICARE: INJURY MANAGEMENT SERVICES, 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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1962454108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INJURY MANAGEMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	3446 MASONIC DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3615
Country	:	US
Telephone Number	:	318-880-0058
Fax Number	:	318-880-0059

Provider Business Practice Location Address
First Line	:	3446 MASONIC DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3615
Country	:	US
Telephone Number	:	318-880-0058
Fax Number	:	318-880-0059

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRUCE M O'DELL
Credential	:	LOTR
Telephone Number	:	318-880-0058

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	01/27/2014

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