Individual
KENNETH CHARLES DEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
8924 BAYONNE DR, SHREVEPORT, LA 71118-2033
(318) 294-1952
Mailing address
127 W BROAD ST, LAKE CHARLES, LA 70601-4393
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
214817
TX
Other
Enumeration date
01/30/2019
Last updated
01/30/2019
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