Provider Demographics
NPI:1184845216
Name:RIDDICK, LORI T (CHT LOTR)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:T
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:CHT LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 HOUMA BLVD
Mailing Address - Street 2:STE 600B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-454-2191
Mailing Address - Fax:504-454-3106
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:STE 600B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-454-2191
Practice Address - Fax:504-454-3106
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTTZ10634225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist