Provider Demographics
NPI:1669789830
Name:NGUYEN, STEPHANIE FLAKE (LOTR)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:FLAKE
Last Name:NGUYEN
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 1:32780 HEMINGWAY AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-2012
Mailing Address - Country:US
Mailing Address - Phone:225-939-9466
Mailing Address - Fax:
Practice Address - Street 1:32780 HEMINGWAY AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-2012
Practice Address - Country:US
Practice Address - Phone:225-939-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12196225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics