Provider Demographics
NPI:1265095798
Name:COURVILLE, SELENA SPICER (LOTR)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:SPICER
Last Name:COURVILLE
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 1:333 LEE DR STE D
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4980
Mailing Address - Country:US
Mailing Address - Phone:225-490-3424
Mailing Address - Fax:225-490-3422
Practice Address - Street 1:333 LEE DR STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4980
Practice Address - Country:US
Practice Address - Phone:225-490-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12135225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist