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General NPI Number Information
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NPI Number | 1750970794
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Entity Type | Individual
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Provider Name | JENNIFER D STOUT
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Gender | Female
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 1515 LA 107
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City | CENTER POINT
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State | LA
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Zip | 71323
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Country | US
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Telephone | 318-452-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 31 ER SLAY RD
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City | DEVILLE
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State | LA
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Zip | 71328-9213
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Country | US
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Telephone | 318-452-8200
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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 | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 200117
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License Number State | LA
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