Shaelyn O'Reilly Bouchard, DPT
Individual provider Active NPI Physical Therapist · Bristol, RI
NPI 1730557232 · NPPES record last updated Jun 22, 2023
Key facts
- NPI
- 1730557232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 21598 (MA)
- Practice address
- 19 Bliven Ave
Bristol, RI 02809-1101 - Phone
- (774) 454-8113
- NPI assigned
- Sep 14, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21598 | MA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT02812 | RI | |
| Physical Therapist | 225100000X | 21598 | MA | Yes |
Addresses
Primary practice location
19 Bliven Ave
Bristol, RI 02809-1101
Mailing address
19 Bliven Ave
Bristol, RI 02809-1101
Phone (774) 454-8113
Other providers in Bristol, RI
- Marjorie Beth Biancuzzo
- Maryann Bishop
- June M Bjerregaard
- Natalie Jamieson Blomdahl
- Rachel Elise Borges
- Katharine Elizabeth Boynton
- Timothy Joseph Brassard
- John L Braun
- Bristol Assisted Living, LP
- Bristol Chiropractic LLC
All providers in Bristol, RI · Physical Therapist in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.