Individual
RANDALL EUGENE SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2575 AIRLINE DR, BOSSIER CITY, LA 71111-5812
(318) 746-7466
Mailing address
318 ACE ST, HAUGHTON, LA 71037-8774
(318) 423-0297
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
200422
LA
Other
Enumeration date
11/16/2014
Last updated
11/16/2014
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