Provider Demographics
NPI:1831713981
Name:DANOS, THERESA AUTIN (MOT, LOTR)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:AUTIN
Last Name:DANOS
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:AUTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, LOTR
Mailing Address - Street 1:7047 HWY 190 E SVC RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4955
Mailing Address - Country:US
Mailing Address - Phone:985-951-2457
Mailing Address - Fax:985-951-2459
Practice Address - Street 1:7047 HWY 190 E SVC RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4955
Practice Address - Country:US
Practice Address - Phone:985-951-2457
Practice Address - Fax:985-951-2459
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200562225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist