Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OTT200310 | LA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OTT200310 | LA |
NPI | 1982034146 |
---|---|
Provider Name | Bryce Teale |
First Address | Marrero, LA 70072-3151 |
Second Address | Marrero, LA 70072-3151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 25/11/2013 |