Provider Demographics
NPI:1306058607
Name:BOATRIGHT, PHILLIP GERALD (OTR)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:GERALD
Last Name:BOATRIGHT
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13821 MARVEN DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1678
Mailing Address - Country:US
Mailing Address - Phone:412-754-2618
Mailing Address - Fax:724-625-4288
Practice Address - Street 1:100 NORTHPOINTE CIR
Practice Address - Street 2:
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7851
Practice Address - Country:US
Practice Address - Phone:724-625-4285
Practice Address - Fax:724-625-4288
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007445L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist