Active NPI
Veronique Broussard
- Occupational Therapist
- Philadelphia, PA
National Provider Identifier
1003578683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OC01823
- Practice address
- 632 W Naomi St
Philadelphia, PA 19144-3711 - Phone
- (267) 245-2601
- NPI assigned
- Oct 11, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OC01823 | PA | Primary |
Addresses
Primary practice location
632 W Naomi St
Philadelphia, PA 19144-3711
Mailing address
632 W Naomi St
Philadelphia, PA 19144-3711
Phone (267) 245-2601
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OC01823 | PA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633910400000",
"number": "1003578683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "632 W NAOMI ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191443711",
"telephone_number": "267-245-2601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "632 W NAOMI ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191443711",
"telephone_number": "267-245-2601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "VERONIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-11",
"last_updated": "2021-10-11",
"certification_date": "2021-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "PA",
"license": "OC01823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.