Provider Demographics
NPI:1841750627
Name:SMITH, TRACI LANE (LOTR)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LANE
Last Name:SMITH
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 1:26300 LA 441 HWY
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:LA
Mailing Address - Zip Code:70744-6004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6723 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8106
Practice Address - Country:US
Practice Address - Phone:225-926-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation