MEDICARE: VICTORIA BOYER BA

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1487076410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA BOYER BA

Provider Business Mailing Address
First Line	:	2405 HOPKINS ST
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3771 SAN JOSE PL
Second Line	:	SUITE 22
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-2436
Country	:	US
Telephone Number	:	904-928-0112
Fax Number	:

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

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	01/10/2014

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