Healthcare Provider Details

I. General information

NPI: 1962893024
Provider Name (Legal Business Name): WAUREEN COLEMAN LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WAUREEN LEE PERRY LOTR

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 OLIVE ST STE 111
SHREVEPORT LA
71104-2246
US

IV. Provider business mailing address

745 OLIVE ST STE 111
SHREVEPORT LA
71104-2246
US

V. Phone/Fax

Practice location:
  • Phone: 318-525-8184
  • Fax:
Mailing address:
  • Phone: 318-525-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ11903
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: