Provider Demographics
NPI:1205221868
Name:BOYER, PHILLIP ROY (MOTL/R)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ROY
Last Name:BOYER
Suffix:
Gender:M
Credentials:MOTL/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 GENESIS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-5531
Mailing Address - Country:US
Mailing Address - Phone:843-389-3685
Mailing Address - Fax:
Practice Address - Street 1:56 GENESIS DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-5531
Practice Address - Country:US
Practice Address - Phone:843-389-3685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist