Provider Demographics
NPI:1194195651
Name:BOYRAZIAN, RUBINA CHRISTINE (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:RUBINA
Middle Name:CHRISTINE
Last Name:BOYRAZIAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 HARBOR VISTA DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5086
Mailing Address - Country:US
Mailing Address - Phone:847-912-6221
Mailing Address - Fax:
Practice Address - Street 1:1885 HARBOR VISTA DR APT 2A
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5086
Practice Address - Country:US
Practice Address - Phone:847-912-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0033652255A2300X
IN31006969A225X00000X
MI5201011319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer