Provider Demographics
NPI:1295948974
Name:BOUCHER, LAURA CAROL (ATC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CAROL
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:C
Other - Last Name:GADINER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:4570 ACKERLY FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9608
Mailing Address - Country:US
Mailing Address - Phone:614-203-3178
Mailing Address - Fax:
Practice Address - Street 1:453 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-2205
Practice Address - Country:US
Practice Address - Phone:614-203-3178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0022082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer