Provider Demographics
NPI:1699404590
Name:FALCON, CAROLINE G (LOTR)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:G
Last Name:FALCON
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 1:270 HIGHWAY 3185
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-7466
Mailing Address - Country:US
Mailing Address - Phone:985-449-0944
Mailing Address - Fax:985-449-0945
Practice Address - Street 1:270 HIGHWAY 3185
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-7466
Practice Address - Country:US
Practice Address - Phone:985-449-0944
Practice Address - Fax:985-449-0945
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA327286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist