Healthcare Provider Details

I. General information

NPI: 1124506969
Provider Name (Legal Business Name): SHELBY RAE MERRIETT-DIGIOVANNI MOT/LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CIRCLE DR
WEST MONROE LA
71291-5305
US

IV. Provider business mailing address

104 CHANTILLY DR
WEST MONROE LA
71291-4702
US

V. Phone/Fax

Practice location:
  • Phone: 318-381-8520
  • Fax: 888-616-5693
Mailing address:
  • Phone: 318-366-4082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number354286
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: