Provider Demographics
NPI:1194036772
Name:BOIRE, THERESA ANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANNE
Last Name:BOIRE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 COUNTY ROUTE 42
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-4001
Mailing Address - Country:US
Mailing Address - Phone:518-747-0307
Mailing Address - Fax:
Practice Address - Street 1:270 COUNTY ROUTE 42
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828
Practice Address - Country:US
Practice Address - Phone:518-747-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009154-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist