Provider Demographics
NPI:1154853281
Name:BOUCHER, CARIANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARIANNE
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SIERRA COLLEGE DR STE 165
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5083
Mailing Address - Country:US
Mailing Address - Phone:530-274-2320
Mailing Address - Fax:
Practice Address - Street 1:300 SIERRA COLLEGE DR STE 165
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5083
Practice Address - Country:US
Practice Address - Phone:530-274-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT8445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist