Healthcare Provider Details

I. General information

NPI: 1578328969
Provider Name (Legal Business Name): ABIGAIL GWINN MOT, LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 18TH ST
METAIRIE LA
70002-4904
US

IV. Provider business mailing address

3105 18TH ST
METAIRIE LA
70002-4904
US

V. Phone/Fax

Practice location:
  • Phone: 504-866-6990
  • Fax:
Mailing address:
  • Phone: 504-866-6990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: