Provider Demographics
NPI:1730471640
Name:BOYLES, KATRINA YONTZ (CBRS)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:YONTZ
Last Name:BOYLES
Suffix:
Gender:F
Credentials:CBRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 PACES PLACE RD
Mailing Address - Street 2:
Mailing Address - City:PINNACLE
Mailing Address - State:NC
Mailing Address - Zip Code:27043-8373
Mailing Address - Country:US
Mailing Address - Phone:336-817-1893
Mailing Address - Fax:336-325-2335
Practice Address - Street 1:1144 PACES PLACE RD
Practice Address - Street 2:
Practice Address - City:PINNACLE
Practice Address - State:NC
Practice Address - Zip Code:27043-8373
Practice Address - Country:US
Practice Address - Phone:336-817-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist