Provider Demographics
NPI:1114294485
Name:BOYD, ANGELA MICHELLE DECKER (OT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE DECKER
Last Name:BOYD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 S PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:IL
Mailing Address - Zip Code:62560-4938
Mailing Address - Country:US
Mailing Address - Phone:217-600-9620
Mailing Address - Fax:
Practice Address - Street 1:3401 HEDLEY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6421
Practice Address - Country:US
Practice Address - Phone:217-600-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist