Provider Demographics
NPI:1881885820
Name:BERTRAND, DENISE (OT)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ASHFORD LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5330
Mailing Address - Country:US
Mailing Address - Phone:337-580-1872
Mailing Address - Fax:
Practice Address - Street 1:810 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-4402
Practice Address - Country:US
Practice Address - Phone:337-684-4251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12120225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist