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NPI Code Detail

MEDICARE: MR. BRUCE M O'DELL LOTR

MEDICARE: MR. BRUCE M O'DELL 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 TherapistZ11902LA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00474235OTHERLARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Z11902OTHERLAOCCUPATIONAL THERAPY LIC#

General Provider Information

NPI Number : 1851342422
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE M O'DELL LOTR
Provider Business Mailing Address
First Line : 3446 MASONIC DR
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-3615
Country : US
Telephone Number : 318-880-0058
Fax Number : 318-880-0059
Provider Business Practice Location Address
First Line : 3446 MASONIC DR
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-3615
Country : US
Telephone Number : 318-880-0058
Fax Number : 318-880-0059
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 12/20/2012

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Directions to “ MR. BRUCE M O'DELL LOTR” Practice Location

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