1801227210 NPI number — MS. MARY ELIZABETH BROUSSARD LOTR

Table of content: MS. MARY ELIZABETH BROUSSARD LOTR (NPI 1801227210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801227210 NPI number — MS. MARY ELIZABETH BROUSSARD LOTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROUSSARD
Provider First Name:
MARY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LOTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801227210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4899 WESTBANK EXPY SUITE D
Provider Second Line Business Mailing Address:
INTEGRATIVE TOUCH PEDIATRIC OCCUPATIONAL THERAPY
Provider Business Mailing Address City Name:
MARRERO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-341-7300
Provider Business Mailing Address Fax Number:
504-328-1800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2655 N. CAUSEWAY BLVD SUITE D
Provider Second Line Business Practice Location Address:
INTEGRATIVE TOUCH PEDIATRIC OCCUPATIONAL THERAPY
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-871-6777
Provider Business Practice Location Address Fax Number:
985-871-6777
Provider Enumeration Date:
12/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OTT.200486 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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