Provider Demographics
NPI:1275868796
Name:O'BOYLE, ROBERTA P
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:P
Last Name:O'BOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8339 BARSTOW DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4444
Mailing Address - Country:US
Mailing Address - Phone:317-431-1541
Mailing Address - Fax:317-229-6374
Practice Address - Street 1:8339 BARSTOW DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4444
Practice Address - Country:US
Practice Address - Phone:317-431-1541
Practice Address - Fax:317-229-6374
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist