MEDICARE: ANGELA P SOILEAU OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	Z10345	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z10345	OTHER	LA	OT LICENSE NUMBER

General Provider Information

NPI Number	:	1477722486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA P SOILEAU OT

Provider Business Mailing Address
First Line	:	319 RULAND ST
Second Line	:
City	:	JENNINGS
State	:	LA
Zip	:	70546-5953
Country	:	US
Telephone Number	:	337-616-8264
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 ELTON RD
Second Line	:	SUITE I
City	:	JENNINGS
State	:	LA
Zip	:	70546-4100
Country	:	US
Telephone Number	:	337-824-5488
Fax Number	:	337-824-5494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2008
Last Update Date	:	02/23/2008

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Directions to “ ANGELA P SOILEAU OT” Practice Location

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