MEDICARE: THILEASEA GAUTHIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OTT.200625	LA

General Provider Information

NPI Number	:	1023705647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THILEASEA GAUTHIER

Provider Business Mailing Address
First Line	:	2423 LARGUIER LN
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-3245
Country	:	US
Telephone Number	:	337-331-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	7414 SUMRALL DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70812-1240
Country	:	US
Telephone Number	:	225-767-2034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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Directions to “ THILEASEA GAUTHIER ” Practice Location

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