Healthcare Provider Details

I. General information

NPI: 1548764616
Provider Name (Legal Business Name): NATALIE BOUCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 N UNIVERSITY DR STE 5
HOLLYWOOD FL
33024-2200
US

IV. Provider business mailing address

3335 N UNIVERSITY DR STE 5
HOLLYWOOD FL
33024-2200
US

V. Phone/Fax

Practice location:
  • Phone: 954-442-9422
  • Fax: 954-442-9150
Mailing address:
  • Phone: 954-442-9422
  • Fax: 954-442-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT18966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: