Provider Demographics
NPI:1609357201
Name:TROUSDALE, LLOYD KEVIN (OTR)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:KEVIN
Last Name:TROUSDALE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BILLIE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5056
Mailing Address - Country:US
Mailing Address - Phone:830-997-8840
Mailing Address - Fax:
Practice Address - Street 1:202 BILLIE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5056
Practice Address - Country:US
Practice Address - Phone:830-997-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist