Provider Demographics
NPI:1679205116
Name:LIFE SUPPORTS
Entity Type:Organization
Organization Name:LIFE SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAMSDELL
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:504-220-9226
Mailing Address - Street 1:2933 SAINT CLAUDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-7226
Mailing Address - Country:US
Mailing Address - Phone:504-220-9226
Mailing Address - Fax:855-320-5571
Practice Address - Street 1:2933 SAINT CLAUDE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-7226
Practice Address - Country:US
Practice Address - Phone:504-220-9226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1324671Medicaid