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General NPI Number Information
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NPI Number | 1619076569
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Entity Type | Individual
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Provider Name | TERTIUS L. AUSTIN III LOTR
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 2110 JUSTICE ST
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City | MONROE
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State | LA
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Zip | 71201-3618
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Country | US
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Telephone | 318-322-8811
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Fax | 318-322-8368
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Provider Business Mailing Address
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Address Line | 2703 W DEBORAH DR
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City | MONROE
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State | LA
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Zip | 71201-2001
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Country | US
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Telephone | 318-372-1115
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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 | Z12100
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License Number State | LA
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