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General NPI Number Information
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NPI Number | 1700221819
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Entity Type | Individual
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Provider Name | REBECCA PRINCE MAGGIO LOTR
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Gender | Female
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 2522 E 70TH ST
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City | SHREVEPORT
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State | LA
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Zip | 71105-4002
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Country | US
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Telephone | 318-798-5918
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Fax |
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Provider Business Mailing Address
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Address Line | 4719 BRUCE ST
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2607
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Country | US
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Telephone | 318-372-7035
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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 | OTT.200610
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License Number State | LA
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