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General NPI Number Information
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NPI Number | 1184753550
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Entity Type | Individual
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Provider Name | JANE BOMER M.O.T., O.T.R.
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Gender | Female
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 4015 INTERSTATE 45 N
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City | CONROE
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State | TX
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Zip | 77304-4901
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Country | US
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Telephone | 936-522-4731
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Fax | 936-522-4737
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Provider Business Mailing Address
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Address Line | 4015 INTERSTATE 45 N
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City | CONROE
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State | TX
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Zip | 77304-4901
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Country | US
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Telephone | 936-522-4731
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Fax | 936-522-4737
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 304475
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License Number State | TX
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