Healthcare Provider Details

I. General information

NPI: 1093148389
Provider Name (Legal Business Name): CHALYA RADER DUGAR LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHALYA SHACONNE RADER LOTR

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SPANISH OAK DR
CARENCRO LA
70520-5778
US

IV. Provider business mailing address

102 SPANISH OAK DR
CARENCRO LA
70520-5778
US

V. Phone/Fax

Practice location:
  • Phone: 337-380-6539
  • Fax:
Mailing address:
  • Phone: 337-380-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOTT.Z12376
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberOTT.Z12376
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOTT.Z12376
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.Z12376
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTT.Z12376
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: