Provider Demographics
NPI:1467233114
Name:BOECK, MITCHELL (COTA)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:BOECK
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2728
Mailing Address - Country:US
Mailing Address - Phone:319-404-7917
Mailing Address - Fax:
Practice Address - Street 1:701 E MAPLELEAF DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-1402
Practice Address - Country:US
Practice Address - Phone:319-385-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant