Provider Demographics
NPI:1134427966
Name:CARLOSS, SUSAN M (LOTR)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:CARLOSS
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 1:103 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7989
Mailing Address - Country:US
Mailing Address - Phone:337-962-4814
Mailing Address - Fax:
Practice Address - Street 1:1130 COOLIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2619
Practice Address - Country:US
Practice Address - Phone:337-261-9188
Practice Address - Fax:337-261-9523
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist