Provider Demographics
NPI:1780237149
Name:LOPEZ, AIMEE BROUSSARD (MOT, LOTR)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:BROUSSARD
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5417
Mailing Address - Country:US
Mailing Address - Phone:337-258-5883
Mailing Address - Fax:
Practice Address - Street 1:108 ENERGY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3818
Practice Address - Country:US
Practice Address - Phone:337-504-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA307044225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics