Healthcare Provider Details

I. General information

NPI: 1972591006
Provider Name (Legal Business Name): DOLLY BARRETT SMITH MPS, LOTR, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 SPRUCE ST
MANDEVILLE LA
70471-2542
US

IV. Provider business mailing address

217 SPRUCE ST
MANDEVILLE LA
70471-2542
US

V. Phone/Fax

Practice location:
  • Phone: 985-630-6711
  • Fax:
Mailing address:
  • Phone: 985-630-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberZ10150
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: