Provider Demographics
NPI:1164957460
Name:COMPREHENSIVE REHABILITATION
Entity Type:Organization
Organization Name:COMPREHENSIVE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LOTR
Authorized Official - Phone:985-714-0923
Mailing Address - Street 1:306 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70392-4148
Mailing Address - Country:US
Mailing Address - Phone:985-714-0923
Mailing Address - Fax:
Practice Address - Street 1:306 CHARLOTTE DR
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:LA
Practice Address - Zip Code:70392-4148
Practice Address - Country:US
Practice Address - Phone:985-714-0923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10870252Y00000X
LA4720252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency