Provider Demographics
NPI:1962605592
Name:BOELK, PATRICIA JO (OTR)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JO
Last Name:BOELK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 JENNY LN
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5596
Mailing Address - Country:US
Mailing Address - Phone:563-332-4382
Mailing Address - Fax:563-332-4382
Practice Address - Street 1:562 N BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-3953
Practice Address - Country:US
Practice Address - Phone:563-242-4070
Practice Address - Fax:563-242-2426
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42137277103OtherJOHN DEERE-UNITED HC
F238375OtherMIDLANDS CHOICE
IA0665265Medicaid
IA70001OtherWELLMARK BCBS OF IOWA
IA0665265Medicaid
IA0665265Medicaid