Individual
ERICK MATTHEW BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
99 E COOKE RD, COLUMBUS, OH 43214-3111
(614) 268-8671
Mailing address
751 BENT OAK DR, BLACKLICK, OH 43004-8821
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.002209
OH
Other
Enumeration date
05/05/2007
Last updated
07/08/2007
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