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NPI Code Detail

MEDICARE: KATELYN COOK HEBERT MOT, LOTR

MEDICARE: KATELYN COOK HEBERT MOT, LOTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOTT.200811LA

General Provider Information

NPI Number : 1245706134
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN COOK HEBERT MOT, LOTR
Provider Business Mailing Address
First Line : 10002 GLEANNLOCH RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71106-7855
Country : US
Telephone Number : 318-510-2088
Fax Number :
Provider Business Practice Location Address
First Line : 4440 VIKING DR STE 200
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-7511
Country : US
Telephone Number : 318-746-1199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2018
Last Update Date : 10/17/2018

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