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NPI Code Detail

MEDICARE: JENNIFER E BOERSMA COTA/L

MEDICARE: JENNIFER E BOERSMA COTA/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
1224Z00000XOccupational Therapy Assistant057004908IL

General Provider Information

NPI Number : 1295211019
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER E BOERSMA COTA/L
Provider Business Mailing Address
First Line : 400 LEGEND LN
Second Line :
City : MCHENRY
State : IL
Zip : 60050-8008
Country : US
Telephone Number : 815-861-1466
Fax Number :
Provider Business Practice Location Address
First Line : 424 N RAND RD
Second Line :
City : NORTH BARRINGTON
State : IL
Zip : 60010-1496
Country : US
Telephone Number : 847-756-2680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2018
Last Update Date : 07/15/2018

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Directions to “ JENNIFER E BOERSMA COTA/L” Practice Location

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