Provider Demographics
NPI:1376269084
Name:BOFFA, MARGARET MARIE (MT-BC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARIE
Last Name:BOFFA
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6348 N MILWAUKEE AVE # 347
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3728
Mailing Address - Country:US
Mailing Address - Phone:818-394-0649
Mailing Address - Fax:
Practice Address - Street 1:6348 N MILWAUKEE AVE # 347
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3728
Practice Address - Country:US
Practice Address - Phone:818-394-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist