Individual provider · NPI-1

Mary Ballard Broussard, OTR

Occupational Therapist · Conroe, TX

NPI number1154892982
StatusActive
Last updated in NPPESDec 5, 2018

Details

NPI
1154892982
Entity type
Individual (NPI-1)
Name
Mary Ballard Broussard
Credential
OTR
Sex
Female
Sole proprietor
No
Enumeration date
Dec 5, 2018
Last updated
Dec 5, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225X00000X Occupational Therapist119236TXYes
225X00000X Occupational TherapistOTT.200764LA

Practice location

704 Longmire Rd Ste 101
Conroe, TX 77304-1850

Phone 985-373-8018

Mailing address

805 Yellow Birch Ln
Conroe, TX 77304-1993

Phone 985-373-8018

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