Healthcare Provider Details

I. General information

NPI: 1568386845
Provider Name (Legal Business Name): YVETTE BOUTIN OTD, MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 HAZELNUT HILL RD
GROTON CT
06340-3268
US

IV. Provider business mailing address

35 MINER AVE
WATERFORD CT
06385-2011
US

V. Phone/Fax

Practice location:
  • Phone: 860-446-8265
  • Fax:
Mailing address:
  • Phone: 307-349-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number48.005217
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: