Provider Demographics
NPI:1154809689
Name:BOISCLAIR, REBECCA SUE (OTR/L)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:BOISCLAIR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1241
Mailing Address - Country:US
Mailing Address - Phone:989-627-9236
Mailing Address - Fax:
Practice Address - Street 1:4436 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2609
Practice Address - Country:US
Practice Address - Phone:810-733-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI520100681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist