Healthcare Provider Details

I. General information

NPI: 1407042542
Provider Name (Legal Business Name): MRS. TONI DAWNYETTE BOGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 ARMSDALE RD
JACKSONVILLE FL
32218-3311
US

IV. Provider business mailing address

12674 ARROWLEAF LN
JACKSONVILLE FL
32225-6848
US

V. Phone/Fax

Practice location:
  • Phone: 904-714-3793
  • Fax:
Mailing address:
  • Phone: 904-221-6562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: