Provider Demographics
NPI:1033564562
Name:GULCZYNSKI, JOHN (LOTR)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GULCZYNSKI
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 1:414 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3702
Mailing Address - Country:US
Mailing Address - Phone:985-732-1651
Mailing Address - Fax:985-241-5400
Practice Address - Street 1:414 AVENUE B
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3702
Practice Address - Country:US
Practice Address - Phone:985-732-1651
Practice Address - Fax:985-241-5400
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist