Provider Demographics
NPI:1720492853
Name:BLACKWELL, SHIRLEY ELIZABETH (LOTR)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ELIZABETH
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:MISS
Other - First Name:SHIRLEY
Other - Middle Name:ELIZABETH
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1745 SW RAILROAD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6150
Mailing Address - Country:US
Mailing Address - Phone:985-310-2160
Mailing Address - Fax:
Practice Address - Street 1:1745 SW RAILROAD AVE STE 302
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6150
Practice Address - Country:US
Practice Address - Phone:985-310-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200721225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics