Provider Demographics
NPI:1629243662
Name:GUERRERO, LANDRY C (LOTR)
Entity Type:Individual
Prefix:
First Name:LANDRY
Middle Name:C
Last Name:GUERRERO
Suffix:
Gender:M
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:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-0052
Mailing Address - Country:US
Mailing Address - Phone:318-649-5111
Mailing Address - Fax:318-502-5040
Practice Address - Street 1:8297 HIGHWAY 165
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-4339
Practice Address - Country:US
Practice Address - Phone:318-649-5111
Practice Address - Fax:318-502-5040
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$0OtherBLUE CROSS/BLUE SHIELD