Provider Demographics
NPI:1538416797
Name:GANUCHEAU, KRISTY MCCOY (LOTR)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:MCCOY
Last Name:GANUCHEAU
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SCARLETT LN
Mailing Address - Street 2:
Mailing Address - City:MONTZ
Mailing Address - State:LA
Mailing Address - Zip Code:70068-8973
Mailing Address - Country:US
Mailing Address - Phone:225-802-7929
Mailing Address - Fax:
Practice Address - Street 1:1055 SAINT CHARLES AVE STE 400
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-3994
Practice Address - Country:US
Practice Address - Phone:225-802-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200572225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist