Provider Demographics
NPI:1073728390
Name:ISTRE LAGASSE, ALLISON
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:ISTRE LAGASSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:CAMILLE
Other - Last Name:ISTRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LOTR
Mailing Address - Street 1:206 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5415
Mailing Address - Country:US
Mailing Address - Phone:337-984-6520
Mailing Address - Fax:
Practice Address - Street 1:206 ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5415
Practice Address - Country:US
Practice Address - Phone:337-984-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12350225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics