MEDICARE: JACQUELINE A BODDY MS, OT

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	225X00000X	Occupational Therapist	5201008144	MI

General Provider Information

NPI Number	:	1285972133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE A BODDY MS, OT

Provider Business Mailing Address
First Line	:	6404 SUSSEX ST
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-2653
Country	:	US
Telephone Number	:	269-271-3585
Fax Number	:

Provider Business Practice Location Address
First Line	:	6404 SUSSEX ST
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-2653
Country	:	US
Telephone Number	:	269-271-3585
Fax Number	:

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

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2026

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