Jennie Moore Bange, LOTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

200202 Issued in LA

Practice address

1501 Kings Hwy
Shreveport, LA 71103-4228

Phone

(318) 813-2972

NPI assigned

Jan 11, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jennie Bange Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ready Set Geaux Therapy

  • Early Intervention Provider Agency
  • Elm Grove, LA
  • NPI 1568931269
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201478400000",
    "number": "1013193879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 OIL FIELD RD",
            "city": "ELM GROVE",
            "state": "LA",
            "postal_code": "710517909",
            "telephone_number": "318-741-6837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-813-2972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE BANGE",
        "first_name": "JENNIE",
        "credential": "LOTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-11",
        "last_updated": "2008-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "LA",
            "license": "200202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIE",
            "last_name": "BANGE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kelsey Kifer Moody, DO
• Komisha Moody
• Lauren K Moody, PLPC
• Patrice Moody
• Tommy Moses Mook, M.D.
• Moore Medical Inc
• Sevetri Moore-Guillaume, MD
• Alicia Shandrell Moore, NP
• Andrea Marie Moore, FNP
• Anna Means Moore, PT, DPT, OCS

• Occupational Therapist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Occupational Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.