Individual
STACEY MARIE LEGROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19503 HIGHWAY 171, DERIDDER, LA 70634
(337) 202-7045
Mailing address
922 BEAU AVE, LAKE CHARLES, LA 70611-4212
(337) 532-8337
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
304418
LA
Other
Enumeration date
01/10/2020
Last updated
01/10/2020
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