Healthcare Provider Details

I. General information

NPI: 1114158433
Provider Name (Legal Business Name): CARLA EILEEN BOYLE OTR-L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 KENNY DR
ATHENS OH
45701-9406
US

IV. Provider business mailing address

1049 WESTERN AVE
CHILLICOTHEE OH
45601-1104
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-3091
  • Fax: 740-773-3985
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-775-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC008628
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: