Healthcare Provider Details

I. General information

NPI: 1144133182
Provider Name (Legal Business Name): KYLIE DANIELLE PERIOUX LOTR/MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 WEAVER RD
LAKE CHARLES LA
70605-5248
US

IV. Provider business mailing address

2115 PIN OAK CT
LAKE CHARLES LA
70605-1133
US

V. Phone/Fax

Practice location:
  • Phone: 318-475-0191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number308395
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: