Healthcare Provider Details

I. General information

NPI: 1740887694
Provider Name (Legal Business Name): ABBY LOU FENNELL O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY LOU HINDS O.T.

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/25/2023
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 ROCKY BAYOU DRIVE
PINEVILLE LA
71360
US

IV. Provider business mailing address

3444 MASONIC DRIVE
ALEXANDRIA LA
71301
US

V. Phone/Fax

Practice location:
  • Phone: 318-545-4120
  • Fax:
Mailing address:
  • Phone: 318-441-8329
  • Fax: 318-441-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number324411
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: