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General NPI Number Information
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NPI Number | 1023588365
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Entity Type | Individual
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Provider Name | DORIS BOUCHARD LCMT
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Gender | Female
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 66 NOOSENECK HILL RD
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City | WEST GREENWICH
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State | RI
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Zip | 02817-1523
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Country | US
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Telephone | 401-397-6663
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Fax |
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Provider Business Mailing Address
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Address Line | 71 HUNGRY HILL RD
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City | STERLING
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State | CT
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Zip | 06377-1819
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Country | US
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Telephone | 860-564-7759
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT01410
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License Number State | RI
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