Provider Demographics
NPI:1710112404
Name:OUBRE, KELEIN LATRICE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELEIN
Middle Name:LATRICE
Last Name:OUBRE
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 1:41176 LAKEWAY COVE AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8949
Mailing Address - Country:US
Mailing Address - Phone:225-939-4460
Mailing Address - Fax:
Practice Address - Street 1:41176 LAKEWAY COVE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8949
Practice Address - Country:US
Practice Address - Phone:225-939-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist