Provider Demographics
NPI:1124147202
Name:BOYLE, ANN MARIE (OTR)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3668 LANGTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1323
Mailing Address - Country:US
Mailing Address - Phone:216-382-3612
Mailing Address - Fax:
Practice Address - Street 1:6606 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4622
Practice Address - Country:US
Practice Address - Phone:216-361-1414
Practice Address - Fax:216-426-1383
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-000125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist