Individual
MS. MICHELLE JEAN BOUDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3300 4TH AVE, CONWAY, SC 29527-6002
(843) 248-5728
Mailing address
238 SUBURBAN ST SW, SHALLOTTE, NC 28470-1702
(910) 443-0867
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
963
SC
Other
Enumeration date
04/22/2007
Last updated
07/08/2007
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