Most Relevant Information
Provider Data
| NPI Number: | 1003396417 |
| Provider Name: | MICHELLE BOUTET RDN, CSSD, LD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 86034676 |
Most Important Dates
| Enumeration Date: | 08/15/2018 |
| Last Updated: | 08/15/2018 |
Provider Practice Location
50 STANIFORD ST FL 10
BOSTON
MA
021142517
Practice Location Phone/Fax
| Phone: | 6176435903 |
| Fax: |
Provider Mailing Location
50 STANIFORD ST FL 10
BOSTON
MA
021142517
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |