Provider Demographics
NPI:1386143477
Name:BOYNTON, TRICIA MADELINE (COTA)
Entity type:Individual
Prefix:MISS
First Name:TRICIA
Middle Name:MADELINE
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 MEADOWDALE RD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009-4615
Mailing Address - Country:US
Mailing Address - Phone:518-925-6113
Mailing Address - Fax:
Practice Address - Street 1:112 OLD JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:NY
Practice Address - Zip Code:12068-5410
Practice Address - Country:US
Practice Address - Phone:518-853-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009366-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty