Provider Demographics
NPI:1497938179
Name:BROUSSARD, YULENE (MS, LOT)
Entity Type:Individual
Prefix:
First Name:YULENE
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:MS, LOT
Other - Prefix:
Other - First Name:YUN-JU
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1522 CASTLE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5706
Mailing Address - Country:US
Mailing Address - Phone:713-213-5336
Mailing Address - Fax:888-448-7650
Practice Address - Street 1:1522 CASTLE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5706
Practice Address - Country:US
Practice Address - Phone:713-213-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist