Healthcare Provider Details

I. General information

NPI: 1205844404
Provider Name (Legal Business Name): MARY LEE BOESEWETTER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 ROCKSIDE RD STE 500
INDEPENDENCE OH
44131-2178
US

IV. Provider business mailing address

1396 BOBBY LN
WESTLAKE OH
44145-1985
US

V. Phone/Fax

Practice location:
  • Phone: 216-459-2846
  • Fax: 216-901-2803
Mailing address:
  • Phone: 440-808-9209
  • Fax: 216-901-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT000492
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: