Individual
MITZI MARTINEZ LEBLANC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 ERNEST ST, LAKE CHARLES, LA 70601-8406
(337) 310-8500
Mailing address
127 W BROAD ST, LAKE CHARLES, LA 70601-4393
(337) 310-8500
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
Z12071
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
512672
—
LA
Enumeration date
01/20/2022
Last updated
01/20/2022
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