Provider Demographics
NPI:1275838682
Name:FONTANA, PAUL ANDRE (OTR)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANDRE
Last Name:FONTANA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4207
Mailing Address - Country:US
Mailing Address - Phone:337-234-7018
Mailing Address - Fax:337-234-3347
Practice Address - Street 1:709 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4207
Practice Address - Country:US
Practice Address - Phone:337-234-7018
Practice Address - Fax:337-234-3347
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10427225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist