Healthcare Provider Details

I. General information

NPI: 1952205304
Provider Name (Legal Business Name): SHAWLA BERGERON LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STADIUM DR
HOUMA LA
70360-2732
US

IV. Provider business mailing address

139 ELSON LN
RACELAND LA
70394-2046
US

V. Phone/Fax

Practice location:
  • Phone: 985-876-7400
  • Fax:
Mailing address:
  • Phone: 985-688-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.Z11933
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: