Individual
MR. ENRICO MASANGKAY ROQUE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
103 PANTHEON LN, SHREVEPORT, LA 71115-4506
(318) 393-1057
Mailing address
103 PANTHEON LN, SHREVEPORT, LA 71115-4506
(318) 393-1057
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.200779
LA
Other
Enumeration date
03/12/2020
Last updated
03/12/2020
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