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Individual

MICHELLE BOUBOULIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
3750 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1742
(571) 306-7999
Mailing address
3750 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1742

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119005611
VA

Other

Enumeration date
01/07/2014
Last updated
01/07/2014
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