Individual
MACIE BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
1603 GOODWIN RD, RUSTON, LA 71270-2907
(318) 255-7550
Mailing address
165 N TANGLEWOOD DR, MINDEN, LA 71055-5630
(318) 525-5261
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
324858
LA
Other
Enumeration date
05/01/2022
Last updated
05/01/2022
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