Individual
MRS. AUDREY JENNINGS VIDRINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCOTA
Contact information
Practice address
3001 ARMAND ST STE I, MONROE, LA 71201-3761
(318) 302-6000
Mailing address
201 EISENHOWER DR, MONROE, LA 71203-6812
(318) 464-0505
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
321501
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
321501
LSBME
LA
Enumeration date
06/03/2022
Last updated
06/03/2022
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