Provider Demographics
NPI:1083702401
Name:BROWN, ANGELLE FALQOUST (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:ANGELLE
Middle Name:FALQOUST
Last Name:BROWN
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6723 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8205
Mailing Address - Country:US
Mailing Address - Phone:225-926-2400
Mailing Address - Fax:225-926-2470
Practice Address - Street 1:6723 JEFFERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8205
Practice Address - Country:US
Practice Address - Phone:225-926-2400
Practice Address - Fax:225-926-2470
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11640225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B515Medicare PIN