MEDICARE: MRS. STEPHANIE FLAKE NGUYEN 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
1	225XP0200X	Pediatric Occupational Therapist	Z12196	LA

General Provider Information

NPI Number	:	1669789830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE FLAKE NGUYEN LOTR

Provider Business Mailing Address
First Line	:	32780 HEMINGWAY AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-2012
Country	:	US
Telephone Number	:	225-939-9466
Fax Number	:

Provider Business Practice Location Address
First Line	:	32780 HEMINGWAY AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-2012
Country	:	US
Telephone Number	:	225-939-9466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

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