Provider Demographics
NPI:1780908996
Name:YANCEY, SUSAN J (LOTR)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:YANCEY
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 1:81174 JIM LOYD RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-7008
Mailing Address - Country:US
Mailing Address - Phone:985-796-0364
Mailing Address - Fax:985-796-8711
Practice Address - Street 1:16191 HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437-5703
Practice Address - Country:US
Practice Address - Phone:985-796-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z15591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist