Provider Demographics
NPI:1073752481
Name:SANFORD, JAMIE CLAIRE (OT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:CLAIRE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 BAYOU BEND DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5147
Mailing Address - Country:US
Mailing Address - Phone:318-349-6610
Mailing Address - Fax:
Practice Address - Street 1:1816 BAYOU BEND DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5147
Practice Address - Country:US
Practice Address - Phone:318-349-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11255225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist