Provider Demographics
NPI:1407910151
Name:GUIDRY, JASON MICHAEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:1700 KALISTE SALOOM RD STE 300
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6187
Practice Address - Country:US
Practice Address - Phone:337-692-1161
Practice Address - Fax:337-269-1169
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1529401Medicaid
LA5CD39Medicare UPIN
LA1529401Medicaid