Healthcare Provider Details

I. General information

NPI: 1871558346
Provider Name (Legal Business Name): MARILYN ELIZABETH BOAZ OTR CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16018 W 65TH ST
SHAWNEE KS
66217
US

IV. Provider business mailing address

21006 W 54TH ST
SHAWNEE KS
66218
US

V. Phone/Fax

Practice location:
  • Phone: 913-248-1461
  • Fax: 913-248-8689
Mailing address:
  • Phone: 913-422-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1700556
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2006000648
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number9511000065
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: