Provider Demographics
NPI:1023287091
Name:METHVIN, JAMIE T (LOTR)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:T
Last Name:METHVIN
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-4221
Mailing Address - Country:US
Mailing Address - Phone:318-352-2369
Mailing Address - Fax:318-357-0565
Practice Address - Street 1:1500 GOLD ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4221
Practice Address - Country:US
Practice Address - Phone:318-352-2369
Practice Address - Fax:318-357-0565
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist