Individual
JENNIFER PERODEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
107 SUMMER LN, WEST MONROE, LA 71291-3501
(318) 396-1969
Mailing address
PO BOX 1377, WEST MONROE, LA 71294-1377
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
308111
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
308111
LOTR LICENSE
LA
Enumeration date
06/01/2020
Last updated
06/01/2020
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