Healthcare Provider Details

I. General information

NPI: 1982199667
Provider Name (Legal Business Name): JORDAN FOLLIS LOTR, CNDT, LSVT BIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7047 HIGHWAY 190 EAST SERVICE RD
COVINGTON LA
70433-4955
US

IV. Provider business mailing address

7047 HIGHWAY 190 EAST SERVICE RD
COVINGTON LA
70433-4955
US

V. Phone/Fax

Practice location:
  • Phone: 985-951-2457
  • Fax: 985-951-2459
Mailing address:
  • Phone: 985-951-2457
  • Fax: 985-951-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTT.200746
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: