Provider Demographics
NPI:1801912118
Name:SAUCIER, BOBBIE-JO (MS, ATC, LATC)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE-JO
Middle Name:
Last Name:SAUCIER
Suffix:
Gender:F
Credentials:MS, ATC, LATC
Other - Prefix:MISS
Other - First Name:BOBBIE-JO
Other - Middle Name:
Other - Last Name:SHEKLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 ROUTE 169
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-3318
Mailing Address - Country:US
Mailing Address - Phone:860-963-9096
Mailing Address - Fax:860-963-2144
Practice Address - Street 1:150 ROUTE 169
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-3318
Practice Address - Country:US
Practice Address - Phone:860-963-9096
Practice Address - Fax:860-963-2144
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0003052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer