Provider Demographics
NPI:1407185192
Name:BOS, MARCY A (COTA)
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:A
Last Name:BOS
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 1:925 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3141
Mailing Address - Country:US
Mailing Address - Phone:269-532-1470
Mailing Address - Fax:269-532-1472
Practice Address - Street 1:925 PARKER AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3141
Practice Address - Country:US
Practice Address - Phone:269-532-1470
Practice Address - Fax:269-532-1472
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI5202003211224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator