Individual
MARISSA D MOUTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
109 WALLACE BROUSSARD RD STE 300A, CARENCRO, LA 70520-6354
(337) 347-6668
(337) 896-8288
Mailing address
1326 CHURCH ST, ZACHARY, LA 70791-2743
(225) 654-8202
(225) 654-4642
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
331797
LA
Other
Enumeration date
06/22/2022
Last updated
06/22/2022
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