MEDICARE: MRS. CONNIE SUE BOGGESS CTRS,OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1239	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841288438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE SUE BOGGESS CTRS,OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 102
Second Line	:	2216 NEWMANS BRANCH ROAD
City	:	MILTON
State	:	WV
Zip	:	25541-0102
Country	:	US
Telephone Number	:	304-634-1845
Fax Number	:	304-743-5267

Provider Business Practice Location Address
First Line	:	2216 NEWMANS BRANCH ROAD
Second Line	:	RURAL ROUTE 3 BOX 397
City	:	MILTON
State	:	WV
Zip	:	25541
Country	:	US
Telephone Number	:	304-634-1845
Fax Number	:	304-743-5267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2005
Last Update Date	:	07/28/2014

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