Provider Demographics
NPI:1073634077
Name:DOUCET, LYNNE PREVOST (LOTR)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:PREVOST
Last Name:DOUCET
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 1:216 WALLACE JOSEPH
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-4519
Mailing Address - Country:US
Mailing Address - Phone:985-851-7218
Mailing Address - Fax:
Practice Address - Street 1:216 WALLACE JOSEPH
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-4519
Practice Address - Country:US
Practice Address - Phone:985-851-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1307530Medicaid