MEDICARE: TIERRA 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
1	225X00000X	Occupational Therapist	R5238	KY
2	225X00000X	Occupational Therapist	116170	TX

General Provider Information

NPI Number	:	1417211186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERRA BOYD OTR/L

Provider Business Mailing Address
First Line	:	8440 N SAM HOUSTON PKWY E
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-2993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 N SAM HOUSTON PKWY E
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-2993
Country	:	US
Telephone Number	:	504-281-5678
Fax Number	:

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

Provider Enumeration Date	:	06/27/2012
Last Update Date	:	03/19/2015

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Directions to “ TIERRA BOYD OTR/L” Practice Location

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