Provider Demographics
NPI:1417605718
Name:BODDEN, JOANNA (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BODDEN
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18833 TOWN RIDGE LN APT 1438
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1621
Mailing Address - Country:US
Mailing Address - Phone:407-590-7060
Mailing Address - Fax:
Practice Address - Street 1:1500 SUNSET DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4724
Practice Address - Country:US
Practice Address - Phone:281-992-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL122504225X00000X
TX122504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist