Provider Demographics
NPI:1407056898
Name:LAURENT, MARISSA F (PT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:F
Last Name:LAURENT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 HIGHWAY 3125
Mailing Address - Street 2:SUITE D
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-5639
Mailing Address - Country:US
Mailing Address - Phone:225-869-0389
Mailing Address - Fax:225-869-0271
Practice Address - Street 1:10900 HIGHWAY 3125
Practice Address - Street 2:SUITE D
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5639
Practice Address - Country:US
Practice Address - Phone:225-869-0389
Practice Address - Fax:225-869-0271
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06300225100000X
LAZ12326225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist