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General NPI Number Information
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NPI Number | 1962365189
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Entity Type | Individual
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Provider Name | LAWANDA RUBY MAE OTIS
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Gender | Female
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2439 MANHATTAN BLVD STE 207
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City | HARVEY
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State | LA
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Zip | 70058-5361
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Country | US
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Telephone | 504-364-8949
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Fax |
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Provider Business Mailing Address
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Address Line | 7021 CHATELAIN DR
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City | NEW ORLEANS
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State | LA
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Zip | 70128-2591
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Country | US
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Telephone | 225-266-0933
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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