Provider Demographics
NPI:1083875363
Name:BOATE, CARLA L (OTRL)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:L
Last Name:BOATE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 N GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-1114
Mailing Address - Country:US
Mailing Address - Phone:419-733-0495
Mailing Address - Fax:
Practice Address - Street 1:253 W 6TH ST
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-1077
Practice Address - Country:US
Practice Address - Phone:419-501-2165
Practice Address - Fax:419-501-2166
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT003819225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist