Provider Demographics
NPI:1144276247
Name:TEMPLE, SONYA RENEE (LCOTA)
Entity type:Individual
Prefix:MS
First Name:SONYA
Middle Name:RENEE
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:LCOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 TENCY TRL
Mailing Address - Street 2:
Mailing Address - City:CASTOR
Mailing Address - State:LA
Mailing Address - Zip Code:71016-4221
Mailing Address - Country:US
Mailing Address - Phone:318-221-8411
Mailing Address - Fax:318-429-5727
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:318-429-5727
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ20291224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant