Individual
KIMBERLEE MARIE BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
159 W 1ST ST, OSWEGO, NY 13126-2045
(315) 342-9575
Mailing address
3630 US ROUTE 11, PULASKI, NY 13142-2161
(315) 509-4232
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
007357-1
NY
Other
Enumeration date
01/11/2010
Last updated
01/11/2010
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