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Individual

PHILLIP D CARPENTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OT

Contact information

Practice address
1418 CROSS LAKE CIRLE, SHREVEPORT, LA 71109-1935
(318) 635-2044
Mailing address
1418 CROSS LAKE CIR, SHREVEPORT, LA 71109-1935
(318) 635-2044

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
Z11082
LA

Other

Enumeration date
06/29/2007
Last updated
07/08/2007
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