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Individual

BLAKE LAGRANGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MOT

Contact information

Practice address
5238 DIJON DR, BATON ROUGE, LA 70808-4311
(225) 906-4097
(225) 650-2357
Mailing address
5238 DIJON DR, BATON ROUGE, LA 70808-4311

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.200470
LA

Other

Enumeration date
11/13/2013
Last updated
11/13/2013
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