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General NPI Number Information
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NPI Number | 1982353181
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Entity Type | Individual
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Provider Name | AERIS BROUSSARD MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 855 S 8TH ST
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City | BEAUMONT
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State | TX
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Zip | 77701-4603
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Country | US
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Telephone | 409-838-6568
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Fax |
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Provider Business Mailing Address
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Address Line | 5350 HEATHERWOOD DR
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City | BEAUMONT
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State | TX
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Zip | 77706-6846
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Country | US
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Telephone | 409-455-3691
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 122495
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 122495
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License Number State | TX
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