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NPI Code Detail

MEDICARE: MRS. SHIRLEY ELIZABETH BLACKWELL LOTR

MEDICARE: MRS. SHIRLEY ELIZABETH BLACKWELL 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
1225XP0200XPediatric Occupational TherapistOTT.200721LA

General Provider Information

NPI Number : 1720492853
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHIRLEY ELIZABETH BLACKWELL LOTR
Provider Business Mailing Address
First Line : 1745 SW RAILROAD AVE STE 302
Second Line :
City : HAMMOND
State : LA
Zip : 70403-6150
Country : US
Telephone Number : 985-310-2160
Fax Number :
Provider Business Practice Location Address
First Line : 1745 SW RAILROAD AVE STE 302
Second Line :
City : HAMMOND
State : LA
Zip : 70403-6150
Country : US
Telephone Number : 985-310-2160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2014
Last Update Date : 04/29/2022

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Directions to “ MRS. SHIRLEY ELIZABETH BLACKWELL LOTR” Practice Location

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