Provider Demographics
NPI:1326751520
Name:BOONE, KARA JORDAN (OTR/L)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:JORDAN
Last Name:BOONE
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 1:1922 WILLESDON DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7691
Mailing Address - Country:US
Mailing Address - Phone:443-243-9883
Mailing Address - Fax:
Practice Address - Street 1:2730 ISABELLA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-8002
Practice Address - Country:US
Practice Address - Phone:904-372-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25173225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist