MEDICARE: LOUSIANA MASSAGE BY TREE HOUSE ENRICHMENTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1649027293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUSIANA MASSAGE BY TREE HOUSE ENRICHMENTS

Provider Business Mailing Address
First Line	:	3320 WARREN DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70814-4056
Country	:	US
Telephone Number	:	225-428-6614
Fax Number	:	225-217-0237

Provider Business Practice Location Address
First Line	:	3103 MONTERREY DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70814-4024
Country	:	US
Telephone Number	:	225-428-6614
Fax Number	:	225-256-0325

Authorized Official
Title or Position	:	CEO/OWNER/MASSAGE THERAPIST
Name	:	CHANICE UNCHELLE BOUDREAUX
Credential	:	LMT
Telephone Number	:	225-428-6614

Provider Enumeration Date	:	05/02/2024
Last Update Date	:	10/27/2025

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