Healthcare Provider Details

I. General information

NPI: 1770797094
Provider Name (Legal Business Name): BOOTHBY THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N MAIN ST
LACONIA NH
03246-2603
US

IV. Provider business mailing address

806 N MAIN ST
LACONIA NH
03246-2603
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-4385
  • Fax: 603-524-1497
Mailing address:
  • Phone: 603-524-4385
  • Fax: 603-524-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER D BOOTHBY
Title or Position: CO-OWNER
Credential: MPA, NHA
Phone: 603-524-4385