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General NPI Number Information
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NPI Number | 1114558665
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Entity Type | Individual
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Provider Name | MELISSA KAY HANSON LOTR
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Gender | Female
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 2509 HARTS BLUFF RD
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City | MANSFIELD
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State | LA
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Zip | 71052-6253
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Country | US
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Telephone | 936-572-7117
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 HARTS BLUFF RD
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City | MANSFIELD
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State | LA
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Zip | 71052-6253
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Country | US
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Telephone | 936-572-7117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 120495
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 321847
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License Number State | LA
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