Healthcare Provider Details

I. General information

NPI: 1194003723
Provider Name (Legal Business Name): VERONICA JO BOESER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W 18TH ST
COZAD NE
69130-1110
US

IV. Provider business mailing address

79145 ROAD 427
BROKEN BOW NE
68822-5123
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-3715
  • Fax: 308-784-3746
Mailing address:
  • Phone: 308-636-8947
  • Fax: 308-210-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1569
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: