Healthcare Provider Details

I. General information

NPI: 1053578724
Provider Name (Legal Business Name): ANGELA NICOLE BOYD MSR, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 WEST DR
CASSATT SC
29032-9283
US

IV. Provider business mailing address

1703 WEST DR
CASSATT SC
29032-9283
US

V. Phone/Fax

Practice location:
  • Phone: 864-303-4622
  • Fax: 864-688-2809
Mailing address:
  • Phone: 864-303-4622
  • Fax: 864-688-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2578
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: