Provider Demographics
NPI:1720216062
Name:LADNER, KEELY MARIE (LOTR)
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:MARIE
Last Name:LADNER
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 1:41280 KEELY LN
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-2352
Mailing Address - Country:US
Mailing Address - Phone:225-647-3443
Mailing Address - Fax:
Practice Address - Street 1:41280 KEELY LN
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2352
Practice Address - Country:US
Practice Address - Phone:225-647-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12084225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist