Active NPI
Gerald Jules Declouet Jr., LOTR
- Occupational Therapist
- Lake Charles, LA
National Provider Identifier
1073200663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTT.Z11817
- Practice address
- 4190 Gerstner Memorial Blvd
Lake Charles, LA 70607-3804 - Phone
- (337) 240-9730
- NPI assigned
- Apr 24, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTT.Z11817 | LA | Primary |
Addresses
Primary practice location
4190 Gerstner Memorial Blvd
Lake Charles, LA 70607-3804
Mailing address
1308 Jefferson Dr
Lake Charles, LA 70605-5540
Phone (337) 853-0770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231027001168 | TX | Practitioner - Occupational Therapist in Private Practice | 6507212529 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTT.Z11817 | LA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682294400000",
"number": "1073200663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1308 JEFFERSON DR",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706055540",
"telephone_number": "337-853-0770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4190 GERSTNER MEMORIAL BLVD",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706073804",
"telephone_number": "337-240-9730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECLOUET",
"first_name": "GERALD",
"middle_name": "JULES",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "LOTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-04-24",
"last_updated": "2023-04-24",
"certification_date": "2023-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "LA",
"license": "OTT.Z11817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.