Provider Demographics
NPI:1073560595
Name:COMPREHENSIVE BALANCE CENTER LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE BALANCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESORMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:337-652-9530
Mailing Address - Street 1:121 TIVOLI ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5150
Mailing Address - Country:US
Mailing Address - Phone:337-652-9530
Mailing Address - Fax:337-289-8970
Practice Address - Street 1:121 TIVOLI ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5150
Practice Address - Country:US
Practice Address - Phone:337-652-9530
Practice Address - Fax:337-289-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty