Individual
MRS. MICHELE JEANNE BOREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
151 LAKEWOOD DR, LULING, LA 70070-6115
(985) 785-7103
Mailing address
151 LAKEWOOD DR, LULING, LA 70070-6115
(985) 785-7103
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OTT.Z11835
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1315460
—
LA
01
—
OTT.Z11835
STATE LICENSE
LA
Enumeration date
03/07/2007
Last updated
07/09/2007
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