Healthcare Provider Details

I. General information

NPI: 1629096466
Provider Name (Legal Business Name): CATHY CHAPMAN GAUTHIER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 OLD JEANERETTE RD
NEW IBERIA LA
70563-5800
US

IV. Provider business mailing address

1307 OLD JEANERETTE RD
NEW IBERIA LA
70563-5800
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-3331
  • Fax: 367-367-6494
Mailing address:
  • Phone: 337-367-3331
  • Fax: 367-367-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ10815
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: