Healthcare Provider Details

I. General information

NPI: 1104008564
Provider Name (Legal Business Name): SONYA S ALLGOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 DOUCET RD A-2
LAFAYETTE LA
70503-3444
US

IV. Provider business mailing address

353 DOUCET RD A-2
LAFAYETTE LA
70503-3444
US

V. Phone/Fax

Practice location:
  • Phone: 337-288-1843
  • Fax: 337-216-7787
Mailing address:
  • Phone: 337-288-1843
  • Fax: 337-216-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.Z11762
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: