Provider Demographics
NPI:1912345554
Name:BOUCHER, PAULETTE JEANNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:JEANNE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3520
Mailing Address - Country:US
Mailing Address - Phone:631-673-4931
Mailing Address - Fax:
Practice Address - Street 1:83 ELM ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3520
Practice Address - Country:US
Practice Address - Phone:631-673-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist