MEDICARE: KAREN BOOSE 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	OT006659	OH

General Provider Information

NPI Number	:	1760908826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN BOOSE OTR/L

Provider Business Mailing Address
First Line	:	3107 GRANTWOOD DR
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-3941
Country	:	US
Telephone Number	:	419-461-0760
Fax Number	:

Provider Business Practice Location Address
First Line	:	17419 SNYDER RD
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-2765
Country	:	US
Telephone Number	:	440-543-9677
Fax Number	:

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

Provider Enumeration Date	:	08/20/2017
Last Update Date	:	08/20/2017

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