Individual
MISS MARY BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, LOTR
Contact information
Practice address
204 E SAINT PETER ST, CARENCRO, LA 70520-4009
(337) 896-6686
(337) 565-6003
Mailing address
2002 JOHNSON ST STE 100, JENNINGS, LA 70546-3640
(337) 824-4547
(337) 824-4548
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
300739
LA
Other
Enumeration date
12/16/2015
Last updated
10/05/2017
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