Provider Demographics
NPI:1952540882
Name:FOSTER, ERIC JONATHAN (LOTR)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JONATHAN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 EDNA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-9221
Mailing Address - Country:US
Mailing Address - Phone:601-337-1724
Mailing Address - Fax:
Practice Address - Street 1:312 CAPE BRETON DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8811
Practice Address - Country:US
Practice Address - Phone:985-645-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSOT1549OtherSTATE LICENSE NUMBER