Individual
MR. MARK P GREMILLION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
2002 JOHNSON ST STE 100, JENNINGS, LA 70546-3646
(337) 824-4547
(337) 824-4548
Mailing address
118 RICHLAND AVE, LAFAYETTE, LA 70508-6606
(337) 824-4547
(337) 824-4548
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
Z10533
LA
Other
Enumeration date
12/26/2006
Last updated
07/08/2007
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