Provider Demographics
NPI:1326519471
Name:ADDO, AUGUSTINA BOATENG
Entity type:Individual
Prefix:
First Name:AUGUSTINA
Middle Name:BOATENG
Last Name:ADDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NEW DAWN TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-2133
Mailing Address - Country:US
Mailing Address - Phone:518-366-5331
Mailing Address - Fax:
Practice Address - Street 1:105 NEW DAWN TRL
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-2133
Practice Address - Country:US
Practice Address - Phone:518-366-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009946-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant