Provider Demographics
NPI:1023008836
Name:BOUTON, JASON CHRISTOPHER (MS AT,C,)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:BOUTON
Suffix:
Gender:M
Credentials:MS AT,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3634
Mailing Address - Country:US
Mailing Address - Phone:203-322-3496
Mailing Address - Fax:203-329-0291
Practice Address - Street 1:1450 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1501
Practice Address - Country:US
Practice Address - Phone:203-667-0387
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer