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General NPI Number Information
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NPI Number | 1932579380
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Entity Type | Individual
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Provider Name | LUCIA JACKSON LOT, CHT
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Gender | Female
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 15476 DEDEAUX RD STE A
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City | GULFPORT
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State | MS
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Zip | 39503-2637
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Country | US
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Telephone | 228-215-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 E LAKE BLVD STE 301
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City | VANCLEAVE
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State | MS
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Zip | 39565-6771
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Country | US
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Telephone | 228-230-2663
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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 | OT-4216
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License Number State | MS
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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 | OTT.Z10872
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License Number State | LA
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