Individual
MRS. JACQUELINE M BOUGHTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
500 UNIVERSITY DR, MC A410, HERSHEY, PA 17033-2360
(800) 243-1455
(717) 531-7269
Mailing address
19 SYCAMORE HILL CT, LEBANON, PA 17042-9785
(717) 270-9998
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP001829L
PA
Other
Enumeration date
01/28/2011
Last updated
01/28/2011
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