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General NPI Number Information
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NPI Number | 1538274915
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Entity Type | Organization
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Legal Business Name | ANN TUBRE LOTR, LLC
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2401 OLIVER RD
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City | MONROE
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State | LA
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Zip | 71201-2934
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Country | US
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Telephone | 318-235-4541
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Fax | 318-323-1200
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Provider Business Mailing Address
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Address Line | 226 CALDWELL RD
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City | WEST MONROE
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State | LA
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Zip | 71291-1627
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Country | US
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Telephone | 318-235-4541
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Fax | 318-232-1200
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Authorized Official
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Title or Position | OWNER, OCCUPATIONAL THERAPIST
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Name | MRS. ANNITA A TUBRE
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Credential | LOTR
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Telephone | 318-235-4541
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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 | Z10523
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License Number State | LA
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