Provider Demographics
NPI:1992799944
Name:FOSTER, SHELLY KING (LOTR)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:KING
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LOTR
Mailing Address - Street 1:265 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-6717
Mailing Address - Country:US
Mailing Address - Phone:318-878-4804
Mailing Address - Fax:
Practice Address - Street 1:160 CHRISTIAN DR
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3645
Practice Address - Country:US
Practice Address - Phone:318-728-4088
Practice Address - Fax:318-728-4124
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA Z11998225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H496Medicare PIN