Healthcare Provider Details

I. General information

NPI: 1790548733
Provider Name (Legal Business Name): SARAH THIBODEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 LA RUE FRANCE STE 108
LAFAYETTE LA
70508-3136
US

IV. Provider business mailing address

1506 NINA HWY
BREAUX BRIDGE LA
70517-7906
US

V. Phone/Fax

Practice location:
  • Phone: 337-242-7931
  • Fax: 337-282-8015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number340262
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: