Individual
MR. KEVIN BOUTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.T.
Contact information
Practice address
90 CLARK AVE # A, TUPELO, MS 38804-2801
(662) 840-0535
(662) 842-7915
Mailing address
90 CLARK AVE # A, TUPELO, MS 38804-2801
(662) 840-0535
(662) 842-7915
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1239
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123797
—
MS
Enumeration date
12/28/2006
Last updated
07/09/2007
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