Active NPI
Elaine Naomi Bouchard, CMT
- Massage Therapist
- Sacramento, CA
National Provider Identifier
1104299775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 36438
- Practice address
- 2414 21St St
Sacramento, CA 95818-2410 - Phone
- (530) 388-0615
- NPI assigned
- Nov 4, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 36438 | CA | Primary |
Addresses
Primary practice location
2414 21St St
Sacramento, CA 95818-2410
Mailing address
9437 Fort Worth Way
Sacramento, CA 95827-1013
Phone (530) 388-0615
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36438 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446595200000",
"number": "1104299775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9437 FORT WORTH WAY",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958271013",
"telephone_number": "530-388-0615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2414 21ST ST",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958182410",
"telephone_number": "530-388-0615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHARD",
"first_name": "ELAINE",
"middle_name": "NAOMI",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-04",
"last_updated": "2015-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "36438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.