Provider Demographics
NPI:1235505462
Name:WILLOUGHBY, EILEEN (OT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MARTENS DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-1617
Mailing Address - Country:US
Mailing Address - Phone:985-320-4159
Mailing Address - Fax:
Practice Address - Street 1:19089 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711-3603
Practice Address - Country:US
Practice Address - Phone:225-209-7140
Practice Address - Fax:225-567-6847
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10575225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist