Healthcare Provider Details

I. General information

NPI: 1922432400
Provider Name (Legal Business Name): JARRETT HAMMOND LOTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MEDICAL DR
BOSSIER CITY LA
71112
US

IV. Provider business mailing address

411 N WASHINGTON AVE STE 5000
DALLAS TX
75246-1792
US

V. Phone/Fax

Practice location:
  • Phone: 318-747-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax: 214-820-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.200814
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: