Individual
CINDY JEAN BOUDREAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
707 STANTON DR, NORTH AUGUSTA, SC 29841-3264
(706) 589-3773
Mailing address
PO BOX 12094, AUGUSTA, GA 30914-2094
(706) 589-3773
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
763
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
763
COTA/L LICENSE OF SC
SC
Enumeration date
08/05/2009
Last updated
08/05/2009
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