Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OTA-046740 | AZ |
NPI | 1003586488 |
---|---|
Provider Name | Courtney Boyce |
First Address | Phoenix, AZ 85044-5079 |
Second Address | Phoenix, AZ 85044-5079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2021 |
Last Update Date | 16/09/2021 |