Provider Demographics
NPI:1033085279
Name:STROUD, SHELLEY RENEE (LOTR)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:STROUD
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 1:166 SHADOW RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEY
Mailing Address - State:LA
Mailing Address - Zip Code:71407-2824
Mailing Address - Country:US
Mailing Address - Phone:318-623-5300
Mailing Address - Fax:
Practice Address - Street 1:566 LOBDELL AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6316
Practice Address - Country:US
Practice Address - Phone:225-925-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200122225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty