Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 005213 | MO |
NPI | 1023084738 |
---|---|
Provider Name | Leslie A Boone |
First Address | Fpo, AP 96538 |
Second Address | Fpo, AP 96538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 08/07/2007 |