Individual
MIRANDA GRACE BOUCARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
8000 YORK RD, TOWSON, MD 21252-4560
(410) 704-5224
Mailing address
110 STRATHDON WAY, TOWSON, MD 21252-4560
(231) 564-0607
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A0001284
MD
2255A2300X
Athletic Trainer
BOC315627
NJ
Other
Enumeration date
05/24/2018
Last updated
09/15/2021
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