Provider Demographics
NPI:1093745606
Name:BREAUX, MONA (OT)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:BREAUX
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 INDUSTRIPLEX BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-295-8183
Mailing Address - Fax:225-752-2937
Practice Address - Street 1:145 ASPEN SQUARE
Practice Address - Street 2:SUITE A
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726
Practice Address - Country:US
Practice Address - Phone:225-667-8989
Practice Address - Fax:225-667-9554
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X139C610Medicare PIN