Healthcare Provider Details

I. General information

NPI: 1386870905
Provider Name (Legal Business Name): SARA LOUISE ELDRIDGE LOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45439 LIVE OAK DRIVE FISCAL DEPARTMENT
HAMMOND LA
70401
US

IV. Provider business mailing address

45439 LIVE OAK DRIVE FISCAL DEPARTMENT
HAMMOND LA
70401
US

V. Phone/Fax

Practice location:
  • Phone: 225-567-3111
  • Fax: 225-567-2017
Mailing address:
  • Phone: 225-567-3111
  • Fax: 225-567-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.Z10970
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: