Provider Demographics
NPI:1831874536
Name:LOETZERICH, KAILEY (MOT, LOTR)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:LOETZERICH
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6601
Mailing Address - Country:US
Mailing Address - Phone:504-517-5437
Mailing Address - Fax:504-533-9272
Practice Address - Street 1:4317 EL DORADO ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6601
Practice Address - Country:US
Practice Address - Phone:504-517-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA337103225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist