Provider Demographics
NPI:1487203741
Name:BOYD, JANICE ANNETTE (COTA)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:ANNETTE
Last Name:BOYD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:ANNETTE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:503 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-1669
Mailing Address - Country:US
Mailing Address - Phone:254-563-4633
Mailing Address - Fax:
Practice Address - Street 1:503 PECAN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1669
Practice Address - Country:US
Practice Address - Phone:254-563-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203274224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant