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General NPI Number Information
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NPI Number | 1538972369
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Entity Type | Individual
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Provider Name | LEAH DOMANGUE
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 7408 HIGHWAY 1
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City | MANSURA
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State | LA
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Zip | 71350-4204
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Country | US
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Telephone | 318-964-2198
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Fax |
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Provider Business Mailing Address
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Address Line | 3598 HIGHWAY 452 APT 5
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City | MARKSVILLE
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State | LA
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Zip | 71351-3581
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Country | US
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Telephone | 985-519-7399
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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