Provider Demographics
NPI:1659514800
Name:BOOTSMA, AUNDREA DANIELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:AUNDREA
Middle Name:DANIELLE
Last Name:BOOTSMA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27050 METCALF RD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-6202
Mailing Address - Country:US
Mailing Address - Phone:913-244-4187
Mailing Address - Fax:
Practice Address - Street 1:27050 METCALF RD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-6202
Practice Address - Country:US
Practice Address - Phone:913-594-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008027303225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist