MEDICARE: MS. TERESA L BOYD INDEPENDENT PROVIDER

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	171W00000X	Contractor	2186432	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2186432	OTHER	OH	INDEPENDENT PROVIDER #

General Provider Information

NPI Number	:	1295788024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA L BOYD INDEPENDENT PROVIDER

Provider Business Mailing Address
First Line	:	1332 CRESTVIEW AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-3544
Country	:	US
Telephone Number	:	330-867-8324
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 CRESTVIEW AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-3544
Country	:	US
Telephone Number	:	330-867-8324
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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