Provider Demographics
NPI:1780778340
Name:NORTHSHORE THERAPY CENTER, LLC
Entity type:Organization
Organization Name:NORTHSHORE THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:VARNADO
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, LOTR
Authorized Official - Phone:985-643-6880
Mailing Address - Street 1:2790 EAST GAUSE BOULEVARD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461
Mailing Address - Country:US
Mailing Address - Phone:985-643-6880
Mailing Address - Fax:985-643-8104
Practice Address - Street 1:2790 EAST GAUSE BOULEVARD
Practice Address - Street 2:SUITE 2
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461
Practice Address - Country:US
Practice Address - Phone:985-643-6880
Practice Address - Fax:985-643-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200062225X00000X, 225XH1200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty