Provider Demographics
NPI:1861008310
Name:BOYCE, JACLYN OLIVIA
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:OLIVIA
Last Name:BOYCE
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 1:4706 COMMONS DR APT 204
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5093
Mailing Address - Country:US
Mailing Address - Phone:518-649-0427
Mailing Address - Fax:
Practice Address - Street 1:4706 COMMONS DR APT 204
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5093
Practice Address - Country:US
Practice Address - Phone:518-649-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019014694225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist