| Doctor Name: | MRS. MARYELLEN WILLETTE BOUTIN |
| NPI Number: | 1427090521 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHYSICAL THERAPIST |
| License Number: | 0400003183 |
| Business Practice Address: | 1 Blanchard Court Montpelier, VT - 05602 |
| Business Phone Number: | 8022296398 |
| Business Fax Number: | 8022295137 |
| Mailing Address: | Po Box 693, WILLISTON |
| State: | VT |
| Postal Code: | 05495 |
| Phone Number: | 8028786656 |
| Fax Number: | 8028786099 |
| NPI Enumeration Date: | 06/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 0400003183 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |