Provider Demographics
NPI:1104604677
Name:BOATMAN, BRITTANY KAYE (COTA/L)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:KAYE
Last Name:BOATMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:KANSAS
Mailing Address - State:OH
Mailing Address - Zip Code:44841-9623
Mailing Address - Country:US
Mailing Address - Phone:419-619-6324
Mailing Address - Fax:
Practice Address - Street 1:355 WINDSOR LN
Practice Address - Street 2:
Practice Address - City:GIBSONBURG
Practice Address - State:OH
Practice Address - Zip Code:43431-1446
Practice Address - Country:US
Practice Address - Phone:419-573-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA005952224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant