Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003284225 |
---|---|
Provider Name | Danielle Nester Faulk |
First Address | Lake Charles, LA 70605-5638 |
Second Address | Lake Charles, LA 70605-5638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2015 |
Last Update Date | 09/06/2017 |