Provider Demographics
NPI:1093205585
Name:BOUCHARD, LINDSAY MARCELLE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:MARCELLE
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4900 IVEY RD NW STE 1720
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4101
Mailing Address - Country:US
Mailing Address - Phone:770-917-5737
Mailing Address - Fax:770-917-5740
Practice Address - Street 1:4900 IVEY RD NW STE 1720
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4101
Practice Address - Country:US
Practice Address - Phone:770-917-5737
Practice Address - Fax:770-917-5740
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006956225X00000X
GAOT006956225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist