Provider Demographics
NPI:1609032366
Name:REMEDIES, MISTY (LOTR)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:
Last Name:REMEDIES
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 1:9967 TRAILRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7678
Mailing Address - Country:US
Mailing Address - Phone:318-798-8485
Mailing Address - Fax:
Practice Address - Street 1:9967 TRAILRIDGE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7678
Practice Address - Country:US
Practice Address - Phone:318-798-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist