Mary Elizabeth Broussard, B.A., B.S.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

Z11181 Issued in LA

Practice address

107 Briarmeadow Dr
Lafayette, LA 70508-7210

Phone

(337) 857-1331

NPI assigned

Aug 27, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Arts, Bachelor of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Synergy Care Southeast LLC

  dba Synergy Care Southeast LLC - Louisiana

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1891156055

  Occupational Therapist

  Medicare reassignment NPD
• Synergy Care Southeast, LLC

  dba Synergy Care Southeast LLC - Texas

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1427466614

  Occupational Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188172800000",
    "number": "1386837953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 BRIARMEADOW DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705087210",
            "telephone_number": "337-857-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 BRIARMEADOW DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705087210",
            "telephone_number": "337-857-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "B.A., B.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-27",
        "last_updated": "2007-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "LA",
            "license": "Z11181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kent Allan Broussard
• Kim P. Broussard, CRNA
• Krystle Robichaux Broussard
• Leenora Broussard, R.PH.
• Mandi Broussard
• Melanie Cavalier Broussard
• Mitchell Neil Broussard, O.D.
• Morgan Broussard, SLP
• Nancy Rebecca Fisher Broussard, OD
• Natalie Broussard, N.P.

• Occupational Therapist in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Occupational Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.