Provider Demographics
NPI:1942923073
Name:FREDERICK, GIGI DANIELLE (LCOTA)
Entity Type:Individual
Prefix:
First Name:GIGI
Middle Name:DANIELLE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:LCOTA
Other - Prefix:
Other - First Name:GIGI
Other - Middle Name:DANIELLE
Other - Last Name:EUBANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCOTA
Mailing Address - Street 1:321 SAMPSON RD
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-8041
Mailing Address - Country:US
Mailing Address - Phone:318-669-1821
Mailing Address - Fax:
Practice Address - Street 1:5444 HWY 2
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263
Practice Address - Country:US
Practice Address - Phone:318-669-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTA.Z20328224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant