MEDICARE: KEITH DIMAGGIO 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	225X00000X	Occupational Therapist	OTT.Z11671	LA

General Provider Information

NPI Number	:	1912464678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH DIMAGGIO LOTR

Provider Business Mailing Address
First Line	:	6851 VICKSBURG ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-3343
Country	:	US
Telephone Number	:	504-382-3865
Fax Number	:

Provider Business Practice Location Address
First Line	:	6851 VICKSBURG ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-3343
Country	:	US
Telephone Number	:	504-382-3865
Fax Number	:

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

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/28/2019

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Directions to “ KEITH DIMAGGIO LOTR” Practice Location

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