Provider Demographics
NPI:1760948764
Name:BOYLAND, CHASSIDY L
Entity Type:Individual
Prefix:
First Name:CHASSIDY
Middle Name:L
Last Name:BOYLAND
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 1:9809 HARMONY DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6501
Mailing Address - Country:US
Mailing Address - Phone:405-313-6011
Mailing Address - Fax:
Practice Address - Street 1:7901 NE 10TH ST STE A106
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3600
Practice Address - Country:US
Practice Address - Phone:405-731-9012
Practice Address - Fax:888-875-1829
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator