Provider Demographics
NPI:1508472010
Name:SIMONEAUX, JORDAN GUEDRY (OTR/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:GUEDRY
Last Name:SIMONEAUX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ANEE'
Other - Last Name:GUEDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2419 W ORICE ROTH RD APT 615
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5318
Mailing Address - Country:US
Mailing Address - Phone:225-614-6442
Mailing Address - Fax:
Practice Address - Street 1:9755 GOODWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4514
Practice Address - Country:US
Practice Address - Phone:225-330-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist