Provider Demographics
NPI:1205215217
Name:BOUANCHAUD, ELIZABETH HUGHS (MOT, LOTR)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HUGHS
Last Name:BOUANCHAUD
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:LOKER
Other - Last Name:HUGHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, LOTR
Mailing Address - Street 1:56 LOUIS PRIMA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 LOUIS PRIMA DR
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5903
Practice Address - Country:US
Practice Address - Phone:985-327-7256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist