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Individual

MARILYN BOUTELLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTA

Contact information

Practice address
1119 OWENS ST N, STILLWATER, MN 55082-4316
(651) 343-3888
Mailing address
1444 ELEANOR AVE, SAINT PAUL, MN 55116-2231
(651) 343-3888

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
201686
MN

Other

Enumeration date
06/29/2011
Last updated
06/29/2011
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