Provider Demographics
NPI:1164183455
Name:BOUTTE, DA'KEA JAUNTE (CLINICAL MASSAGE)
Entity Type:Individual
Prefix:MISS
First Name:DA'KEA
Middle Name:JAUNTE
Last Name:BOUTTE
Suffix:
Gender:F
Credentials:CLINICAL MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 LEITNER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2923
Mailing Address - Country:US
Mailing Address - Phone:843-323-1631
Mailing Address - Fax:
Practice Address - Street 1:7306 LEITNER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2923
Practice Address - Country:US
Practice Address - Phone:843-323-1631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12455225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist