Provider Demographics
NPI:1912720236
Name:BOYER, CORYNN (OTR/L, OTD)
Entity type:Individual
Prefix:
First Name:CORYNN
Middle Name:
Last Name:BOYER
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 MAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-2766
Mailing Address - Country:US
Mailing Address - Phone:314-560-8361
Mailing Address - Fax:
Practice Address - Street 1:220 LOCUST ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-2829
Practice Address - Country:US
Practice Address - Phone:636-231-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024041407225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist