Healthcare Provider Details

I. General information

NPI: 1073712394
Provider Name (Legal Business Name): MICHELLE DUPLECHIN MCCRORY LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE LOUISE DUPLECHIN LOTR

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RHINE RD SE
WHITE GA
30184-3476
US

IV. Provider business mailing address

725 RHINE RD SE
WHITE GA
30184-3476
US

V. Phone/Fax

Practice location:
  • Phone: 604-628-5604
  • Fax:
Mailing address:
  • Phone: 504-628-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT005338
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: