MEDICARE: MRS. HOLLY BATEMAN LOTR, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OTT.Z11893	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OTT.Z11893	OTHER	LA	LOUISIANA STATE BOARD OF MEDICAL EXAMINERS

General Provider Information

NPI Number	:	1518385996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY BATEMAN LOTR, MS

Provider Business Mailing Address
First Line	:	10514 STRINGER BRIDGE RD
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-4217
Country	:	US
Telephone Number	:	225-571-0131
Fax Number	:	225-675-6806

Provider Business Practice Location Address
First Line	:	10514 STRINGER BRIDGE RD
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-4217
Country	:	US
Telephone Number	:	225-571-0131
Fax Number	:	225-675-6806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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