Provider Demographics
NPI:1285753095
Name:CANTRELLE, DANIELLE BUQUET (LOTR)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:BUQUET
Last Name:CANTRELLE
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 1:510 BAYOU GARDENS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364
Mailing Address - Country:US
Mailing Address - Phone:985-860-7453
Mailing Address - Fax:985-872-3205
Practice Address - Street 1:620 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-872-3285
Practice Address - Fax:985-872-3205
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12327225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1475998Medicaid
LA196641Medicare ID - Type Unspecified