Individual
JENNIE MOORE BANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 813-2972
Mailing address
522 OIL FIELD RD, ELM GROVE, LA 71051-7909
(318) 741-6837
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
200202
LA
Other
Enumeration date
01/11/2008
Last updated
01/28/2008
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