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NPI Code Detail

MEDICARE: PATCHEZ LONG LOTR

MEDICARE: PATCHEZ LONG 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.200328LA

General Provider Information

NPI Number : 1558694901
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATCHEZ LONG LOTR
Provider Business Mailing Address
First Line : PO BOX 1377
Second Line :
City : WEST MONROE
State : LA
Zip : 71294-1377
Country : US
Telephone Number : 318-396-1969
Fax Number : 318-396-1970
Provider Business Practice Location Address
First Line : 107 SUMMER LN
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-3501
Country : US
Telephone Number : 318-396-1969
Fax Number : 318-396-1970
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2009
Last Update Date : 09/16/2009

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Directions to “ PATCHEZ LONG LOTR” Practice Location

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