Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OTT.Z10772 | LA |
Y | 225XH1200X | Occupational Therapist - Hand | OTT.Z10772 | LA |
NPI | 1164421178 |
---|---|
Provider Name | Mr. Gary Anthony Guidry |
First Address | Maurice, LA 70555-3707 |
Second Address | Lafayette, LA 70508-5739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 01/04/2015 |