Individual
EMILY S BOULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
800 E MILHAM AVE, PORTAGE, MI 49002-1490
(269) 986-5432
Mailing address
800 E MILHAM AVE, PORTAGE, MI 49002-1490
(269) 986-5432
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201010153
MI
Other
Enumeration date
08/17/2021
Last updated
08/17/2021
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