Healthcare Provider Details

I. General information

NPI: 1386562163
Provider Name (Legal Business Name): BLAIRE CHRISTIAN FONTENOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S RANGE AVE
DENHAM SPRINGS LA
70726-4810
US

IV. Provider business mailing address

1310 S RANGE AVE
DENHAM SPRINGS LA
70726-4810
US

V. Phone/Fax

Practice location:
  • Phone: 225-380-1894
  • Fax: 225-380-1896
Mailing address:
  • Phone: 225-380-1894
  • Fax: 225-380-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number352944
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: