Individual
JANETTE BOOTH KNOBLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
601 HOLY TRINITY DR, COVINGTON, LA 70433-6230
(985) 718-1192
Mailing address
1505 RUE HAMLET, COVINGTON, LA 70433-6436
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
Z11735
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z11735
LA BOARD MEDICAL EXAMINER
LA
Enumeration date
06/11/2017
Last updated
06/11/2017
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