Provider Demographics
NPI:1558898304
Name:TUMBLESTON, DONALD ALLEN JR (LOTR)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ALLEN
Last Name:TUMBLESTON
Suffix:JR
Gender:M
Credentials:LOTR
Other - Prefix:
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Mailing Address - Street 1:14394 S LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5777
Mailing Address - Country:US
Mailing Address - Phone:985-634-5608
Mailing Address - Fax:985-892-4724
Practice Address - Street 1:14394 S LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-5777
Practice Address - Country:US
Practice Address - Phone:985-634-5608
Practice Address - Fax:985-892-4724
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12499225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision