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General NPI Number Information
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NPI Number | 1962614859
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Entity Type | Individual
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Provider Name | KAREN PATRICIA BOUTIETTE OTR
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 733 W CLAIREMONT AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6101
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Country | US
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Telephone | 715-838-5222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860912
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0912
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Country | US
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Telephone | 715-838-5222
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3049-026
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License Number State | WI
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