Provider Demographics
NPI:1679692859
Name:BILLIOTT, LORI GIPSON (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:GIPSON
Last Name:BILLIOTT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:GIPSON
Other - Last Name:MCKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:1483 N PUMPING STATION RD
Mailing Address - Street 2:
Mailing Address - City:OVETT
Mailing Address - State:MS
Mailing Address - Zip Code:39464-3553
Mailing Address - Country:US
Mailing Address - Phone:601-344-8259
Mailing Address - Fax:
Practice Address - Street 1:1483 N PUMPING STATION RD
Practice Address - Street 2:
Practice Address - City:OVETT
Practice Address - State:MS
Practice Address - Zip Code:39464-3553
Practice Address - Country:US
Practice Address - Phone:601-344-8259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1985225X00000X
LAOTT.Z12072225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist