Provider Demographics
NPI:1568662526
Name:BOYD, ANGELA MASON (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MASON
Last Name:BOYD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:MASON
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L, MOT
Mailing Address - Street 1:344 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-7516
Mailing Address - Country:US
Mailing Address - Phone:812-637-9789
Mailing Address - Fax:812-637-3542
Practice Address - Street 1:344 SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-7516
Practice Address - Country:US
Practice Address - Phone:812-637-9789
Practice Address - Fax:812-637-3542
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003094A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist