Provider Demographics
NPI:1467633180
Name:RICHARDSON, STAN (MOT)
Entity Type:Individual
Prefix:MR
First Name:STAN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:18852 HWY 124
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-0011
Mailing Address - Country:US
Mailing Address - Phone:318-452-5166
Mailing Address - Fax:
Practice Address - Street 1:18852 HIGHWAY 124
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343-7714
Practice Address - Country:US
Practice Address - Phone:318-452-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist