Individual
JESSICA DIANNE BOUDREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1260 N JOHNSON ST, KAHOKA, MO 63445-1100
(660) 727-3303
Mailing address
1260 N JOHNSON ST, KAHOKA, MO 63445-1100
(660) 727-3303
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2015038298
MO
Other
Enumeration date
12/01/2015
Last updated
12/01/2015
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