Individual provider · NPI-1

Mary Elizabeth Broussard, B.A., B.S.

Occupational Therapist · Lafayette, LA

NPI number1386837953
StatusActive
Last updated in NPPESAug 27, 2007

Details

NPI
1386837953
Entity type
Individual (NPI-1)
Name
Mrs. Mary Elizabeth Broussard
Credential
B.A., B.S.
Sex
Female
Sole proprietor
No
Enumeration date
Aug 27, 2007
Last updated
Aug 27, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225X00000X Occupational TherapistZ11181LAYes

Practice location

107 Briarmeadow Dr
Lafayette, LA 70508-7210

Phone 337-857-1331

Mailing address

107 Briarmeadow Dr
Lafayette, LA 70508-7210

Phone 337-857-1331

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