Provider Demographics
NPI:1841939485
Name:SCHULTZ, ALYSSA BASS (LOTR)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BASS
Last Name:SCHULTZ
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 1:2995 HIGHWAY 500
Mailing Address - Street 2:
Mailing Address - City:TROUT
Mailing Address - State:LA
Mailing Address - Zip Code:71371-3112
Mailing Address - Country:US
Mailing Address - Phone:318-201-7524
Mailing Address - Fax:
Practice Address - Street 1:3600 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3040
Practice Address - Country:US
Practice Address - Phone:318-201-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA325868224Z00000X
LA345781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant