MEDICARE: BRANDI GAUTREAUX OT

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.Z12103	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821216102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI GAUTREAUX OT

Provider Business Mailing Address
First Line	:	817 BAYOU OAK LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2629
Country	:	US
Telephone Number	:	337-274-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 BAYOU OAK LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2629
Country	:	US
Telephone Number	:	337-274-6744
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	05/24/2012

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