Provider Demographics
NPI:1598981458
Name:BOINEAU, PEGGY JEANINE
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JEANINE
Last Name:BOINEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 FREEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:TX
Mailing Address - Zip Code:77486-9667
Mailing Address - Country:US
Mailing Address - Phone:979-345-6313
Mailing Address - Fax:
Practice Address - Street 1:305 N MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480-2801
Practice Address - Country:US
Practice Address - Phone:979-798-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108070225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand