Provider Demographics
NPI:1073200663
Name:DECLOUET, GERALD JULES JR (LOTR)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:JULES
Last Name:DECLOUET
Suffix:JR
Gender:M
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5540
Mailing Address - Country:US
Mailing Address - Phone:337-853-0770
Mailing Address - Fax:
Practice Address - Street 1:4190 GERSTNER MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-3804
Practice Address - Country:US
Practice Address - Phone:337-240-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist