Provider Demographics
NPI:1548568090
Name:GUIDRY, ANDRE JOSEPH (OT)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:JOSEPH
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-8045
Mailing Address - Country:US
Mailing Address - Phone:985-637-1004
Mailing Address - Fax:985-369-4568
Practice Address - Street 1:108 ELLINGTON DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-8045
Practice Address - Country:US
Practice Address - Phone:985-637-1004
Practice Address - Fax:985-369-4568
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11343225XG0600X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology