Provider Demographics
NPI:1871898148
Name:BOUCHARD, ASHLEY MARCELLE (PTA)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:MARCELLE
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LIBERTY HILL RD
Mailing Address - Street 2:PO BOX 616
Mailing Address - City:HENNIKER
Mailing Address - State:NH
Mailing Address - Zip Code:03242-3045
Mailing Address - Country:US
Mailing Address - Phone:603-470-3030
Mailing Address - Fax:
Practice Address - Street 1:30 COLBY CT
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6426
Practice Address - Country:US
Practice Address - Phone:603-470-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1020225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant