Provider Demographics
NPI:1477108025
Name:EISERLOH, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:EISERLOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 S CLEARVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3401
Mailing Address - Country:US
Mailing Address - Phone:504-736-1865
Mailing Address - Fax:
Practice Address - Street 1:822 S CLEARVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:LA
Practice Address - Zip Code:70123-3401
Practice Address - Country:US
Practice Address - Phone:504-736-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA312796225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1477108025Medicaid