Provider Demographics
NPI:1912448044
Name:FOSTER, ANNA (IBCLC, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:IBCLC, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 KATHY CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4402
Mailing Address - Country:US
Mailing Address - Phone:949-463-2330
Mailing Address - Fax:
Practice Address - Street 1:6212 KATHY CIR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4402
Practice Address - Country:US
Practice Address - Phone:949-463-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1248225X00000X
LA328491225X00000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist