Healthcare Provider Details

I. General information

NPI: 1215849849
Provider Name (Legal Business Name): RONALD ISAAC SMITH LOTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7406 HIGHWAY 1 STE 102
MANSURA LA
71350-4230
US

IV. Provider business mailing address

PO BOX 849
JENNINGS LA
70546-0849
US

V. Phone/Fax

Practice location:
  • Phone: 318-240-7680
  • Fax: 318-240-7681
Mailing address:
  • Phone: 337-824-8287
  • Fax: 337-824-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number344974
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: