Provider Demographics
NPI:1477566099
Name:BOURCIER, CAROLINE (MSPT, OCS)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:BOURCIER
Suffix:
Gender:F
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:BOURCIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:9 LA LOMA CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5147
Mailing Address - Country:US
Mailing Address - Phone:415-497-6557
Mailing Address - Fax:
Practice Address - Street 1:9 LA LOMA CT
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5147
Practice Address - Country:US
Practice Address - Phone:415-497-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 20963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist