Provider Demographics
NPI:1417027863
Name:GALA, MANILAL R (OTR)
Entity Type:Individual
Prefix:PROF
First Name:MANILAL
Middle Name:R
Last Name:GALA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 JAMES COMEAUX RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3255
Mailing Address - Country:US
Mailing Address - Phone:337-261-1935
Mailing Address - Fax:337-261-1938
Practice Address - Street 1:145 JAMES COMEAUX RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3255
Practice Address - Country:US
Practice Address - Phone:337-261-1935
Practice Address - Fax:337-261-1938
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z10234225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA79751OtherBCBS PROVIDER NUMBER
LA79751OtherBCBS PROVIDER NUMBER
LA721224499OtherCLINIC TAX ID NUMBER