Provider Demographics
NPI:1003942038
Name:BOUCHER, CERISE MARIE (ATC)
Entity Type:Individual
Prefix:MS
First Name:CERISE
Middle Name:MARIE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:VT
Mailing Address - Zip Code:05735-9254
Mailing Address - Country:US
Mailing Address - Phone:802-671-8052
Mailing Address - Fax:
Practice Address - Street 1:CASTLETON UNIVERSITY
Practice Address - Street 2:190 UNIVERSITY DRIVE
Practice Address - City:CASTLETON
Practice Address - State:VT
Practice Address - Zip Code:05735-0573
Practice Address - Country:US
Practice Address - Phone:802-468-1435
Practice Address - Fax:802-468-2189
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT10400000612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer