Individual
DARETH LYNN WAGUESPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
821 N BURNSIDE AVE, GONZALES, LA 70737-2835
(225) 939-7205
(225) 647-9503
Mailing address
13058 L LANDRY RD, GONZALES, LA 70737-6001
(225) 715-7551
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.Z12146
LA
Other
Enumeration date
04/24/2020
Last updated
04/24/2020
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