Provider Demographics
NPI:1821711680
Name:ALTOM, AMI MICHELLE (M ED)
Entity Type:Individual
Prefix:MRS
First Name:AMI
Middle Name:MICHELLE
Last Name:ALTOM
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6095 HWY 105
Mailing Address - Street 2:
Mailing Address - City:GLOSTER
Mailing Address - State:LA
Mailing Address - Zip Code:71030
Mailing Address - Country:US
Mailing Address - Phone:337-308-5329
Mailing Address - Fax:
Practice Address - Street 1:6095 HWY 105
Practice Address - Street 2:
Practice Address - City:GLOSTER
Practice Address - State:LA
Practice Address - Zip Code:71030
Practice Address - Country:US
Practice Address - Phone:337-308-5329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator