Provider Demographics
NPI:1194506170
Name:SONNENFELD, CHARLOTTE (LOT)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:
Last Name:SONNENFELD
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 E WILDERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6140
Mailing Address - Country:US
Mailing Address - Phone:318-344-4001
Mailing Address - Fax:
Practice Address - Street 1:1950 E 70TH ST STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5345
Practice Address - Country:US
Practice Address - Phone:318-344-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist