Provider Demographics
NPI:1588820823
Name:BOUDREAUX, DONNA P (LOTR)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:P
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52522
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2522
Mailing Address - Country:US
Mailing Address - Phone:337-981-4053
Mailing Address - Fax:337-981-2448
Practice Address - Street 1:2727 KALISTE SALOOM RD
Practice Address - Street 2:101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7151
Practice Address - Country:US
Practice Address - Phone:337-981-4053
Practice Address - Fax:337-981-2448
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11238225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist