Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3773-026 | WI |
N | 225XE0001X | Environmental Modification | ||
N | 225XG0600X | Occupational Therapist - Gerontology | ||
N | 225XM0800X | Mental Health | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1962779116 |
---|---|
Provider Name | Nicole Elizabeth Boyington |
First Address | Waukesha, WI 53186-5490 |
Second Address | Waukesha, WI 53186-5490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2011 |
Last Update Date | 19/05/2020 |