Individual
JACQUELINE R BOUTHOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
14 MURRAY DR, GORHAM, ME 04038-4105
(207) 233-7373
(888) 731-2721
Mailing address
14 MURRAY DR, GORHAM, ME 04038-4105
(207) 233-7373
(888) 731-2721
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2603
ME
Other
Enumeration date
12/08/2012
Last updated
12/08/2012
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