Provider Demographics
NPI:1740666593
Name:DOSS, MARY ELISE (OT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELISE
Last Name:DOSS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
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Mailing Address - Street 1:1300 HUDSON LN STE 7
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6054
Mailing Address - Country:US
Mailing Address - Phone:318-322-6500
Mailing Address - Fax:
Practice Address - Street 1:1300 HUDSON LN STE 7
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6054
Practice Address - Country:US
Practice Address - Phone:318-361-7180
Practice Address - Fax:318-582-5615
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308761225X00000X
LAOTA.200391224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant