Provider Demographics
NPI:1982199667
Name:FOLLIS, JORDAN (LOTR, CNDT, LSVT BIG)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:FOLLIS
Suffix:
Gender:F
Credentials:LOTR, CNDT, LSVT BIG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7047 HIGHWAY 190 EAST SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4955
Mailing Address - Country:US
Mailing Address - Phone:985-951-2457
Mailing Address - Fax:985-951-2459
Practice Address - Street 1:7047 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4955
Practice Address - Country:US
Practice Address - Phone:985-951-2457
Practice Address - Fax:985-951-2459
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200746225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAOTT.200746OtherLOUISIANA STATE BOARD OF MEDICAL EXAMINERS