Provider Demographics
NPI:1760922124
Name:CANCIENNE, STEPHANIE (LOTR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CANCIENNE
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HOLY TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6230
Mailing Address - Country:US
Mailing Address - Phone:985-605-0484
Mailing Address - Fax:
Practice Address - Street 1:601 HOLY TRINITY DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6230
Practice Address - Country:US
Practice Address - Phone:985-605-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist