Provider Demographics
NPI:1477626224
Name:PORTER, LAKOYA NEOSHA (LOTR)
Entity Type:Individual
Prefix:MS
First Name:LAKOYA
Middle Name:NEOSHA
Last Name:PORTER
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 1:7003 NORTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-1730
Mailing Address - Country:US
Mailing Address - Phone:225-205-8452
Mailing Address - Fax:
Practice Address - Street 1:9534 DELCOURT AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4122
Practice Address - Country:US
Practice Address - Phone:225-926-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4H630C943Medicare ID - Type Unspecified