Provider Demographics
NPI:1720046352
Name:BOYER, MICHAEL CHARLES (OTRL ASHT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:BOYER
Suffix:
Gender:M
Credentials:OTRL ASHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 S CEDAR CREST BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6212
Mailing Address - Country:US
Mailing Address - Phone:610-509-6944
Mailing Address - Fax:610-770-6390
Practice Address - Street 1:1230 S CEDAR CREST BLVD STE 306
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6212
Practice Address - Country:US
Practice Address - Phone:610-509-6944
Practice Address - Fax:610-770-6390
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000047L225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
5763056OtherAETNA
50000056OtherCAPITAL BLUE CROSS
PA1034710001Medicare NSC
PA625534Medicare PIN