Healthcare Provider Details

I. General information

NPI: 1932321718
Provider Name (Legal Business Name): KIRSTEN NOEL EVANS-ROMANO LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN NOEL EVANS ROMANO LOTR

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7865
US

IV. Provider business mailing address

PO BOX 41151
BATON ROUGE LA
70835-1151
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-8666
  • Fax: 225-791-8644
Mailing address:
  • Phone: 225-819-7360
  • Fax: 225-769-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ12161
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: