Provider Demographics
NPI:1639744576
Name:GREEN GABLES THERAPY LLC
Entity Type:Organization
Organization Name:GREEN GABLES THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:318-488-0893
Mailing Address - Street 1:5445 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-8365
Mailing Address - Country:US
Mailing Address - Phone:318-488-0893
Mailing Address - Fax:
Practice Address - Street 1:5445 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-8365
Practice Address - Country:US
Practice Address - Phone:318-488-0893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty