Provider Demographics
NPI:1669503116
Name:BOEHM, ANGELA M II
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BOEHM
Suffix:II
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 1:3341 E QUEEN CREEK RD STE 109
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8510
Mailing Address - Country:US
Mailing Address - Phone:480-621-8361
Mailing Address - Fax:480-621-8513
Practice Address - Street 1:3341 E QUEEN CREEK RD STE 109
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8510
Practice Address - Country:US
Practice Address - Phone:480-621-8361
Practice Address - Fax:480-621-8513
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
AZ4297225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist