Provider Demographics
NPI:1316173131
Name:CASTILLION, MARY M
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:CASTILLION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N MORRISON BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2312
Mailing Address - Country:US
Mailing Address - Phone:985-543-4113
Mailing Address - Fax:
Practice Address - Street 1:620 N MORRISON BLVD STE G
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2312
Practice Address - Country:US
Practice Address - Phone:985-543-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11834225X00000X
LAOTTZ11834225XH1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors