Provider Demographics
NPI:1922139500
Name:STEVENS, SHANNON BARRILLEAUX (LOTR)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:BARRILLEAUX
Last Name:STEVENS
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 1:56309 CURRIER LN
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-2749
Mailing Address - Country:US
Mailing Address - Phone:985-878-9207
Mailing Address - Fax:985-878-9551
Practice Address - Street 1:56309 CURRIER LN
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-2749
Practice Address - Country:US
Practice Address - Phone:985-878-9207
Practice Address - Fax:985-878-9551
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z10927225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1322466Medicaid