Provider Demographics
NPI:1609584945
Name:BOETTCHER, CHARLOTTE CLAIRE (MSOT)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:CLAIRE
Last Name:BOETTCHER
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 S ANGUILLA RD
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1430
Mailing Address - Country:US
Mailing Address - Phone:203-592-3643
Mailing Address - Fax:
Practice Address - Street 1:31 VAUXHALL ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5723
Practice Address - Country:US
Practice Address - Phone:860-442-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT02128225X00000X
CT19547110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist