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General NPI Number Information
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NPI Number | 1609062793
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Entity Type | Individual
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Provider Name | MICHELE A BOUTILIER LHIS
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Gender | Female
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 2400 N. CROATOAN HWY SUITE G
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City | KILL DEVIL HILLS
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State | NC
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Zip | 27948
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Country | US
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Telephone | 252-441-2595
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Fax | 252-441-2595
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Provider Business Mailing Address
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Address Line | 128 ACORN LANE
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City | POINT HARBOR
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State | NC
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Zip | 27964
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Country | US
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Telephone | 252-441-2595
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Fax | 252-441-2595
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1003
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License Number State | NC
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