Provider Demographics
NPI:1841625829
Name:MARIONEAUX, CHEREZ KAILYNN (LMT)
Entity type:Individual
Prefix:MISS
First Name:CHEREZ
Middle Name:KAILYNN
Last Name:MARIONEAUX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6165 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-1610
Mailing Address - Country:US
Mailing Address - Phone:225-978-6180
Mailing Address - Fax:225-357-0519
Practice Address - Street 1:8768 QUARTERS LAKE RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2195
Practice Address - Country:US
Practice Address - Phone:225-978-6180
Practice Address - Fax:225-357-0519
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA7480225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist