Provider Demographics
NPI:1952075996
Name:WEATHERSBY, JAVA HARRELL (LOT)
Entity Type:Individual
Prefix:
First Name:JAVA
Middle Name:HARRELL
Last Name:WEATHERSBY
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:MISS
Other - First Name:JAVA
Other - Middle Name:MAURICE
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LOTR
Mailing Address - Street 1:23916 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6879
Mailing Address - Country:US
Mailing Address - Phone:504-583-1261
Mailing Address - Fax:
Practice Address - Street 1:56369 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:504-583-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTTZ1139225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty