Provider Demographics
NPI:1821399585
Name:LEBLANC, DONALD L (LOTR)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:LEBLANC
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 1:301 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4722
Mailing Address - Country:US
Mailing Address - Phone:225-664-1166
Mailing Address - Fax:225-667-2843
Practice Address - Street 1:301 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4722
Practice Address - Country:US
Practice Address - Phone:225-664-1166
Practice Address - Fax:225-667-2843
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12067225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist