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General NPI Number Information
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NPI Number | 1366227597
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Entity Type | Individual
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Provider Name | ABBY B CUPIT RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 247 VILLERE DR
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City | DESTREHAN
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State | LA
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Zip | 70047-2513
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Country | US
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Telephone | 985-210-3571
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Fax |
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Provider Business Mailing Address
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Address Line | 247 VILLERE DR
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City | DESTREHAN
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State | LA
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Zip | 70047-2513
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Country | US
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Telephone | 985-210-3571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 3657
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 3657
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License Number State | LA
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