Provider Demographics
NPI:1386056497
Name:BOYD, JAMES ROY (MOT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROY
Last Name:BOYD
Suffix:
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:21806 103RD AVENUE CT E
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8115
Practice Address - Country:US
Practice Address - Phone:253-847-3700
Practice Address - Fax:253-847-9622
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60470911225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1386056497Medicaid
WA0328062OtherDEPT. OF LABOR AND INDUSTRIES
WA1386056497Medicaid