Individual
SHAELYN O'REILLY BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
19 BLIVEN AVE, BRISTOL, RI 02809-1101
(774) 454-8113
Mailing address
19 BLIVEN AVE, BRISTOL, RI 02809-1101
(774) 454-8113
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
21598
MA
225100000X
Physical Therapist
PT02812
RI
Other
Enumeration date
09/14/2015
Last updated
06/22/2023
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