Provider Demographics
NPI:1134458987
Name:BOONE, DAVID (MS/OTRL)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BOONE
Suffix:
Gender:M
Credentials:MS/OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 BROOKTREE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9260
Mailing Address - Country:US
Mailing Address - Phone:724-940-3468
Mailing Address - Fax:724-940-3484
Practice Address - Street 1:5500 BROOKTREE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9260
Practice Address - Country:US
Practice Address - Phone:724-940-3468
Practice Address - Fax:724-940-3484
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010180225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist