Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | Z11343 | LA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | Z11343 | LA |
NPI | 1548568090 |
---|---|
Provider Name | Andre Joseph Guidry |
First Address | Thibodaux, LA 70301-8045 |
Second Address | Thibodaux, LA 70301-8045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2011 |
Last Update Date | 08/03/2011 |