Individual
JUDITH VESTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
1501 KINGS HWY, LSUHSC FACULTY REHAB CLINIC, SHREVEPORT, LA 71103-4228
(318) 675-5000
Mailing address
1501 KINGS HWY, LSUHSC FACULTY REHAB CLINIC, SHREVEPORT, LA 71103-4228
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
06926
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144265976
GROUP NPI NUMBER
LA
05
—
1174173
—
LA
Enumeration date
10/24/2006
Last updated
07/09/2007
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