Provider Demographics
NPI:1568679058
Name:BOATMAN, DARA DAWN (M A CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:DAWN
Last Name:BOATMAN
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 6820
Mailing Address - Street 2:
Mailing Address - City:VICI
Mailing Address - State:OK
Mailing Address - Zip Code:73859-9116
Mailing Address - Country:US
Mailing Address - Phone:580-995-3223
Mailing Address - Fax:
Practice Address - Street 1:800 N. ARAPAHO
Practice Address - Street 2:
Practice Address - City:HYDRO
Practice Address - State:OK
Practice Address - Zip Code:73048
Practice Address - Country:US
Practice Address - Phone:405-663-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist