Caroline Bordelon Detraz

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OTT.200079 Issued in LA

Practice address

204 E Saint Peter St
Carencro, LA 70520-4009

Phone

(337) 896-6686

Fax

(337) 565-6003

NPI assigned

Nov 22, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Caroline Christine Bordelon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lemoine Therapy Services of Cenla Inc

  • Physical Therapist
  • Mansura, LA
  • NPI 1336242767

  Occupational Therapist

  NPD (past)
• Physical Therapy Clinic of Carencro LLC

  • Physical Therapist
  • Carencro, LA
  • NPI 1669557906
  NPD (past)
• Physical Therapy Clinic of Lafayette, LLC

  • Physical Therapist
  • Lafayette, LA
  • NPI 1114471612

  Occupational Therapist

  NPD (past)

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487721600000",
    "number": "1598748741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 JOHNSON ST",
            "address_2": "SUITE 100",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705463640",
            "telephone_number": "337-824-4547",
            "fax_number": "337-824-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E SAINT PETER ST",
            "city": "CARENCRO",
            "state": "LA",
            "postal_code": "705204009",
            "telephone_number": "337-896-6686",
            "fax_number": "337-565-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETRAZ",
        "first_name": "CAROLINE",
        "middle_name": "BORDELON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-22",
        "last_updated": "2017-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "2806",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "LA",
            "license": "OTT.200079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLINE",
            "last_name": "BORDELON",
            "middle_name": "CHRISTINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• DDMS of Louisiana No 2, LLC
• Dedicated to U
• Delta Transportation LLC
• Jacob Earon Derrickson, DDS
• Designer Express Transport LLC
• DFM Case Management LLC
• Jennifer H Doerle, PT, DPT
• Rebecca Doise, M.D.
• Avis Schoelen Domingue, MA, RD,LDN,CDE
• Hailey Doucet, PHARMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.