MEDICARE: MRS. KRISTEN NICOLE BOSSE MMS, OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT10804	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124145982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN NICOLE BOSSE MMS, OTRL

Provider Business Mailing Address
First Line	:	4978 SW 90TH TER
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-3517
Country	:	US
Telephone Number	:	954-434-4276
Fax Number	:	954-252-8459

Provider Business Practice Location Address
First Line	:	4978 SW 90TH TER
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-3517
Country	:	US
Telephone Number	:	954-434-4276
Fax Number	:	954-252-8459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	08/12/2010

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