Individual
ANSLEY FUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
1033 WILTON PL, SHREVEPORT, LA 71107-2817
(318) 402-2995
Mailing address
1033 WILTON PL, SHREVEPORT, LA 71107-2817
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
120474
TX
Other
Enumeration date
01/04/2020
Last updated
01/04/2020
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