Provider Demographics
NPI:1790025062
Name:ECKHARDT, CASEY SCARBOROUGH (MOT, LOTR, PT, DPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:SCARBOROUGH
Last Name:ECKHARDT
Suffix:
Gender:F
Credentials:MOT, LOTR, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 ALONZO RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1731
Mailing Address - Country:US
Mailing Address - Phone:318-381-9337
Mailing Address - Fax:
Practice Address - Street 1:502 STERLINGTON HWY
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-3111
Practice Address - Country:US
Practice Address - Phone:318-381-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT 08698225100000X
LAOTT.200620225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist