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General NPI Number Information
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NPI Number | 1912123480
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Entity Type | Individual
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Provider Name | VERNON MOSS LOTR
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 109 KIOWA ST
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City | MONROE
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State | LA
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Zip | 71203-8565
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Country | US
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Telephone | 318-557-1672
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Fax | 318-345-2862
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Provider Business Mailing Address
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Address Line | 109 KIOWA ST
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City | MONROE
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State | LA
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Zip | 71203-8565
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Country | US
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Telephone | 318-557-1672
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Fax | 318-345-2862
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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 | Z10600
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License Number State | LA
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