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NPI Code Detail

MEDICARE: MRS. KATHERINE ADCOCK BOYD OTR/L

MEDICARE: MRS. KATHERINE ADCOCK BOYD OTR/L
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
1225X00000XOccupational TherapistOTT.200604LA

General Provider Information

NPI Number : 1194218743
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHERINE ADCOCK BOYD OTR/L
Provider Business Mailing Address
First Line : 18242 OAK LANE AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-3718
Country : US
Telephone Number : 502-640-5040
Fax Number :
Provider Business Practice Location Address
First Line : 5130 MANCUSO LN
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-3583
Country : US
Telephone Number : 225-490-9600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2018
Last Update Date : 06/08/2018

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