Individual
MR. JACOB RANDALL PONDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LOTR
Contact information
Practice address
307 REGISTER ST, WEST MONROE, LA 71291-2737
(318) 329-8998
(318) 329-8997
Mailing address
300 FIDDLERS CREEK DR, WEST MONROE, LA 71291-1769
(318) 397-9796
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.Z12342
LA
Other
Enumeration date
08/08/2006
Last updated
07/08/2007
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