Provider Demographics
NPI:1801237318
Name:STEWART, LAINE WOODRUFF (MOT, CHT)
Entity type:Individual
Prefix:
First Name:LAINE
Middle Name:WOODRUFF
Last Name:STEWART
Suffix:
Gender:F
Credentials:MOT, CHT
Other - Prefix:
Other - First Name:LAINE
Other - Middle Name:MARGARET
Other - Last Name:WOODRUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:4221 OLD GENTILLY RD STE C
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-4901
Practice Address - Country:US
Practice Address - Phone:504-435-1468
Practice Address - Fax:504-435-1775
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200656225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP01259674OtherMEDICARE RAILROAD
LA314755YUZ5OtherMEDICARE PTAN
874984OtherOPTUM
LA314755YWWBOtherMEDICARE PTAN