Healthcare Provider Details

I. General information

NPI: 1306766860
Provider Name (Legal Business Name): CIARA LAVERGNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W BROAD ST STE 850
LAKE CHARLES LA
70601-4394
US

IV. Provider business mailing address

2346 WILDER RD
CROWLEY LA
70526-7022
US

V. Phone/Fax

Practice location:
  • Phone: 405-985-9770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number353263
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: