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General NPI Number Information
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NPI Number | 1043402183
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Entity Type | Individual
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Provider Name | ROXIE BROUSSARD OTR
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 400 E SAYLES ST
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City | BRENHAM
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State | TX
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Zip | 77833-2358
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Country | US
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Telephone | 979-836-6828
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Fax |
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Provider Business Mailing Address
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Address Line | 9395 MAPES ST
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City | BEAUMONT
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State | TX
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Zip | 77707-1156
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Country | US
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Telephone | 832-928-2403
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 105215
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License Number State | TX
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