Healthcare Provider Details

I. General information

NPI: 1619802337
Provider Name (Legal Business Name): CAMRYN BROUILLETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 FLORIDA ST
BATON ROUGE LA
70806-3757
US

IV. Provider business mailing address

3140 FLORIDA ST
BATON ROUGE LA
70806-3757
US

V. Phone/Fax

Practice location:
  • Phone: 225-478-1174
  • Fax:
Mailing address:
  • Phone: 225-654-8208
  • Fax: 225-529-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number340079
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: