Provider Demographics
NPI:1518601798
Name:BOUDREAUX, SADIE MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:MICHELLE
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:MICHELLE
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:120 WHITE ROSE DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2644
Practice Address - Country:US
Practice Address - Phone:985-532-9662
Practice Address - Fax:985-532-3942
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA323435224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant