Individual
MRS. TANYA CANNON RACHAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LOT
Contact information
Practice address
3761 ROSEDALE RD, PORT ALLEN, LA 70767-4305
(225) 603-5151
Mailing address
9516 CAMMY AVE, BATON ROUGE, LA 70815-4356
(225) 603-5151
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
Z12410
LA
Other
Enumeration date
10/16/2006
Last updated
05/11/2021
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