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NPI Code Detail

MEDICARE: MRS. REBECCA PRINCE MAGGIO LOTR

MEDICARE: MRS. REBECCA PRINCE MAGGIO 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.200610LA

General Provider Information

NPI Number : 1700221819
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA PRINCE MAGGIO LOTR
Provider Business Mailing Address
First Line : 4719 BRUCE ST
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-2607
Country : US
Telephone Number : 318-372-7035
Fax Number :
Provider Business Practice Location Address
First Line : 2522 E 70TH ST
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-4002
Country : US
Telephone Number : 318-798-5918
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2013
Last Update Date : 05/02/2013

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