Provider Demographics
NPI:1689871824
Name:DOOLITTLE, KELLIE S (LOTR)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:S
Last Name:DOOLITTLE
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:L
Other - Last Name:SCHULINGKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LOTR
Mailing Address - Street 1:980 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:980 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5519
Practice Address - Country:US
Practice Address - Phone:434-987-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20-2541563OtherTAX ID ADVANCE HAND SPECIALIST DBA MCMILLIAN CORPORTAION
LA27-1727146OtherTAXPAYER IDENITIFICATION NUMBER MCMILLIAN CORPORATION