Provider Demographics
NPI:1225457302
Name:BEAUDREAU, SARAH POUSSON (LOTR, MOT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:POUSSON
Last Name:BEAUDREAU
Suffix:
Gender:F
Credentials:LOTR, MOT
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:TERESA
Other - Last Name:POUSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LOTR, MOT
Mailing Address - Street 1:621 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-4319
Mailing Address - Country:US
Mailing Address - Phone:225-445-3875
Mailing Address - Fax:
Practice Address - Street 1:621 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-4319
Practice Address - Country:US
Practice Address - Phone:225-445-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200502225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist