# ACTIVE MOVEMENT REHABILITATION AND WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588895791
- **Authorized official:** MRS. KANDYL K DOMANGUE OTR/L (OWNER)
- **Authorized official phone:** (985) 209-9239

## Contact information

- **Practice address:** 127 HIGHWAY 22 E, UNIT N5, MADISONVILLE, LA 70447-9306
- **Practice address phone:** (985) 209-9239
- **Mailing address:** PO BOX 918, MANDEVILLE, LA 70470-0918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | OTT.200287 | LA | Yes |

## Other

- **Enumeration date:** 08/05/2009
- **Last updated:** 08/05/2009