Individual
MR. RUSSEL BIENVENU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
101 ISADORE ST, NATCHITOCHES, LA 71457-5747
(318) 238-2810
(318) 238-2811
Mailing address
101 ISADORE ST, NATCHITOCHES, LA 71457-5747
(318) 238-2810
(318) 238-2811
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.Z10858
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTT.Z10858
LOUISIANA STATE LICENSE
LA
Enumeration date
02/23/2010
Last updated
02/23/2010
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