Provider Demographics
NPI:1588957252
Name:BASNIGHT, LACONYA RENE (LOTR)
Entity type:Individual
Prefix:MRS
First Name:LACONYA
Middle Name:RENE
Last Name:BASNIGHT
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 1:8254 ORMAND DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-7129
Mailing Address - Country:US
Mailing Address - Phone:225-654-2584
Mailing Address - Fax:
Practice Address - Street 1:8254 ORMAND DR
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7129
Practice Address - Country:US
Practice Address - Phone:225-654-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11819225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist