Provider Demographics
NPI:1982020798
Name:WELCH, JOHANNA SIEGEL (COTA)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:SIEGEL
Last Name:WELCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:LOVANNE
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465-0323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1646 MILITARY HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5042
Practice Address - Country:US
Practice Address - Phone:318-443-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ20626224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant