Provider Demographics
NPI:1700028594
Name:CHISHOLM, EILEEN BECNEL (PT, OT)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:BECNEL
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:PT, OT
Other - Prefix:MS
Other - First Name:EILEEN
Other - Middle Name:ANN
Other - Last Name:BECNEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1314 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7641
Mailing Address - Country:US
Mailing Address - Phone:225-206-2133
Mailing Address - Fax:
Practice Address - Street 1:17000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3246
Practice Address - Country:US
Practice Address - Phone:225-752-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200285225X00000X
LA07619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3B340Medicare PIN
3B377Medicare PIN