Provider Demographics
NPI:1982335766
Name:MOUTON, MARISSA D (OT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:D
Last Name:MOUTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:B
Other - Last Name:DOUCET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1326 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2743
Mailing Address - Country:US
Mailing Address - Phone:225-654-8202
Mailing Address - Fax:225-654-4642
Practice Address - Street 1:109 WALLACE BROUSSARD RD STE 300A
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-6354
Practice Address - Country:US
Practice Address - Phone:337-347-6668
Practice Address - Fax:337-896-8288
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA331797225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist