Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | Z12207 | LA |
NPI | 1073623955 |
---|---|
Provider Name | Stacy Thompson Corder |
First Address | Baton Rouge, LA 70809-6126 |
Second Address | Baton Rouge, LA 70809-6126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |