MEDICARE: KRISTY MCCOY GANUCHEAU LOTR

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.200572	LA

General Provider Information

NPI Number	:	1538416797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY MCCOY GANUCHEAU LOTR

Provider Business Mailing Address
First Line	:	105 SCARLETT LN
Second Line	:
City	:	MONTZ
State	:	LA
Zip	:	70068-8973
Country	:	US
Telephone Number	:	225-802-7929
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 SAINT CHARLES AVE STE 400
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70130-3994
Country	:	US
Telephone Number	:	225-802-7929
Fax Number	:

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	09/04/2024

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