Provider Demographics
NPI:1124353818
Name:BOUCHARD, YOLAINE SIMONE
Entity type:Individual
Prefix:MRS
First Name:YOLAINE
Middle Name:SIMONE
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-3422
Mailing Address - Country:US
Mailing Address - Phone:954-274-5670
Mailing Address - Fax:954-317-5656
Practice Address - Street 1:8120 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-3422
Practice Address - Country:US
Practice Address - Phone:954-274-5670
Practice Address - Fax:954-317-5656
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist