Individual
GLYNN R MELANCON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.T.
Contact information
Practice address
3730 BLAIR DR, LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONALS, SHREVEPORT, LA 71103-4602
(318) 632-2030
(318) 675-7737
Mailing address
3730 BLAIR DR, LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONALS, SHREVEPORT, LA 71103-4602
(318) 632-2030
(318) 675-7737
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174173
—
LA
Enumeration date
07/27/2006
Last updated
07/09/2007
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