Provider Demographics
NPI:1932773173
Name:SPROUT PEDIATRIC THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:SPROUT PEDIATRIC THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:BARRILLEAUX
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:985-351-1394
Mailing Address - Street 1:56309 CURRIER LN
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-2749
Mailing Address - Country:US
Mailing Address - Phone:985-351-1394
Mailing Address - Fax:
Practice Address - Street 1:56309 CURRIER LN
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-2749
Practice Address - Country:US
Practice Address - Phone:985-351-1394
Practice Address - Fax:985-878-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency