Healthcare Provider Details

I. General information

NPI: 1669503116
Provider Name (Legal Business Name): ANGELA M BOEHM II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 E QUEEN CREEK RD STE 109
GILBERT AZ
85297-8510
US

IV. Provider business mailing address

3341 E QUEEN CREEK RD STE 109
GILBERT AZ
85297-8510
US

V. Phone/Fax

Practice location:
  • Phone: 480-621-8361
  • Fax: 480-621-8513
Mailing address:
  • Phone: 480-621-8361
  • Fax: 480-621-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4297
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: