Provider Demographics
NPI:1063671675
Name:BOLTON LEMOINE, MICHELLE L (LOTR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BOLTON LEMOINE
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 N 7TH ST STE 230
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4444
Mailing Address - Country:US
Mailing Address - Phone:318-331-2769
Mailing Address - Fax:
Practice Address - Street 1:2106 N 7TH ST STE 230
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4444
Practice Address - Country:US
Practice Address - Phone:318-600-6640
Practice Address - Fax:318-605-2662
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT200167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist