Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTT.Z11361 | LA |
NPI | 1255097275 |
---|---|
Provider Name | Sonya Denae Pailette |
First Address | Rayville, LA 71269-5770 |
Second Address | Rayville, LA 71269-3645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2021 |
Last Update Date | 14/11/2021 |