Provider Demographics
NPI:1346916855
Name:GUERIN, MARY BETH
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:GUERIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19281 LA HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:LETTSWORTH
Mailing Address - State:LA
Mailing Address - Zip Code:70753-3216
Mailing Address - Country:US
Mailing Address - Phone:225-718-3146
Mailing Address - Fax:
Practice Address - Street 1:337 NAPOLEON STRETT
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760
Practice Address - Country:US
Practice Address - Phone:225-638-8674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12280225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist