Provider Demographics
NPI:1972913630
Name:LAGRONE, ANGEL CHENEVERT (OT)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:CHENEVERT
Last Name:LAGRONE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12362 PECAN ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:JARREAU
Mailing Address - State:LA
Mailing Address - Zip Code:70749-3217
Mailing Address - Country:US
Mailing Address - Phone:225-931-0204
Mailing Address - Fax:
Practice Address - Street 1:12362 PECAN ISLAND RD
Practice Address - Street 2:
Practice Address - City:JARREAU
Practice Address - State:LA
Practice Address - Zip Code:70749-3217
Practice Address - Country:US
Practice Address - Phone:225-931-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist