Eli William Wallace, OT
Individual provider Active NPI Occupational Therapist · Lafayette, LA
NPI 1891538070 · NPPES record last updated Jun 17, 2024
Key facts
- NPI
- 1891538070
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OTT.200733 (LA)
- Practice address
- 400 Polly LN
Lafayette, LA 70508-4966 - Phone
- (337) 443-0652
- NPI assigned
- Jun 17, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Louisiana Physical Therapy Services of Lafayette, LLC
Acadian Physical Therapy Services LLC
Practice addresses (Care Compare)
2201 Verot School Rd
Lafayette, LA 70508-6469
Phone (337) 344-0509
400 Polly LN
Suite 160
Lafayette, LA 70508-4966
Phone (337) 500-1300
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240723002998 | LA | Practitioner - Occupational Therapist in Private Practice | 7810433125 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acadian Physical Therapy Services, LLC | Occupational Therapist | Current |
Accepting new patients |
| Louisiana Physical Therapy Services of Lafayette LLC | Occupational Therapist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTT.200733 | LA | Yes |
Addresses
Primary practice location
400 Polly LN
Lafayette, LA 70508-4966
Mailing address
105 Concerto CRST
Duson, LA 70529-3352
Phone (337) 258-5264
Other providers in Lafayette, LA
- Matthew Luther Walker
- Shaun Walker
- Amanda Wallace
- Dana Wallace
- Dionne Wallace
- Maria Hebert Wallace
- Sarah L Wallace
- Lane Jhase Waller
- Billie Sue Wallis
- Judy Werger Wallis
All providers in Lafayette, LA · Occupational Therapist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.