Active NPI
Daniel P. Waller, LOTR
- Occupational Therapist
- Hammond, LA
National Provider Identifier
1790146686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTT.200844
- Practice address
- 2101 Robin Ave Ste 4
Hammond, LA 70403-5774 - Phone
- (985) 230-6160
- Fax
- (985) 230-6248
- NPI assigned
- Mar 18, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTT.200844 | LA | Primary |
Addresses
Primary practice location
2101 Robin Ave Ste 4
Hammond, LA 70403-5774
Mailing address
40080 N Rateau Rd
Ponchatoula, LA 70454-8822
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTT.200844 | LA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458259200000",
"number": "1790146686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40080 N RATEAU RD",
"city": "PONCHATOULA",
"state": "LA",
"postal_code": "704548822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 ROBIN AVE STE 4",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704035774",
"telephone_number": "985-230-6160",
"fax_number": "985-230-6248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "DANIEL",
"middle_name": "P.",
"name_prefix": "Mr.",
"credential": "LOTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-18",
"last_updated": "2016-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "LA",
"license": "OTT.200844",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hammond, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.