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General NPI Number Information
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NPI Number | 1861067399
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Entity Type | Individual
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Provider Name | CHERYL STIPE RUDD LOT
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Gender | Female
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 221 TUNICA DR W
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City | MARKSVILLE
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State | LA
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Zip | 71351-2603
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Country | US
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Telephone | 318-253-5982
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Fax |
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Provider Business Mailing Address
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Address Line | 9021 PINE MOSS DR
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City | BATON ROUGE
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State | LA
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Zip | 70817-6930
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Country | US
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Telephone | 225-931-8049
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | Z10642
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License Number State | LA
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