Basic Information
| Provider Information | |||||||||
| NPI: | 1922432400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMMOND | ||||||||
| FirstName: | JARRETT | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | LOTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 N WASHINGTON AVE STE 5000 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752461792 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 2148209560 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187479500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2013 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OTT.200814 | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.