Provider Demographics
NPI:1447082185
Name:MICHOT, JEREMY JAMES (LOTR)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:JAMES
Last Name:MICHOT
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 1:128 SWEETWATER RIM
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5492
Mailing Address - Country:US
Mailing Address - Phone:318-264-9175
Mailing Address - Fax:
Practice Address - Street 1:5723 JACKSON ST EXT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2079
Practice Address - Country:US
Practice Address - Phone:318-449-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200048225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist