Healthcare Provider Details

I. General information

NPI: 1437499555
Provider Name (Legal Business Name): JENNIFER K BOYER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MADISON OAK DR
SAN ANTONIO TX
78258
US

IV. Provider business mailing address

22023 KENTON KNL
SAN ANTONIO TX
78258-7848
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-4000
  • Fax:
Mailing address:
  • Phone: 210-760-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056010040
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number117028
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: