Provider Demographics
NPI:1518431329
Name:SOUTHEAST OT LLC
Entity Type:Organization
Organization Name:SOUTHEAST OT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:907-314-0081
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0877
Mailing Address - Country:US
Mailing Address - Phone:907-314-0081
Mailing Address - Fax:
Practice Address - Street 1:206 PIEDAD ROAD
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827
Practice Address - Country:US
Practice Address - Phone:907-314-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty