Individual
MRS. MARY BOUDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
279 CABOT ST, HOLYOKE, MA 01040-3139
(413) 536-3435
(413) 536-8259
Mailing address
279 CABOT ST, HOLYOKE, MA 01040-3139
(413) 536-3435
(413) 536-8259
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2378
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2378
STATE MASS OTA LICENSE
MA
Enumeration date
11/23/2015
Last updated
11/23/2015
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