Provider Demographics
NPI:1962786509
Name:ROBINSON, SHONTELL LOLITA (OT)
Entity type:Individual
Prefix:
First Name:SHONTELL
Middle Name:LOLITA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-2026
Mailing Address - Country:US
Mailing Address - Phone:504-975-1706
Mailing Address - Fax:
Practice Address - Street 1:503 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-2026
Practice Address - Country:US
Practice Address - Phone:504-975-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT. 200212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist