Provider Demographics
NPI:1801227210
Name:BROUSSARD, MARY ELIZABETH (LOTR)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BROUSSARD
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Gender:F
Credentials:LOTR
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Other - Credentials:
Mailing Address - Street 1:4899 WESTBANK EXPY SUITE D
Mailing Address - Street 2:INTEGRATIVE TOUCH PEDIATRIC OCCUPATIONAL THERAPY
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-341-7300
Mailing Address - Fax:504-328-1800
Practice Address - Street 1:2655 N. CAUSEWAY BLVD SUITE D
Practice Address - Street 2:INTEGRATIVE TOUCH PEDIATRIC OCCUPATIONAL THERAPY
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471
Practice Address - Country:US
Practice Address - Phone:985-871-6777
Practice Address - Fax:985-871-6777
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
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Provider Licenses
StateLicense IDTaxonomies
LAOTT.200486225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist