Provider Demographics
NPI:1851687198
Name:PEDIATRIC THERAPY AND LEARNING CENTER OF THE NORTHSHORE, LLC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY AND LEARNING CENTER OF THE NORTHSHORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:LOTR
Authorized Official - Phone:985-294-3582
Mailing Address - Street 1:220 PARK PL STE 201
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5267
Mailing Address - Country:US
Mailing Address - Phone:985-898-2999
Mailing Address - Fax:985-898-2289
Practice Address - Street 1:220 PARK PL STE 201
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5267
Practice Address - Country:US
Practice Address - Phone:985-898-2999
Practice Address - Fax:985-898-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12153225XP0200X
LA4981235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty