Provider Demographics
NPI:1891962098
Name:BOIVIN PACKARD, CARLEY ANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CARLEY
Middle Name:ANNE
Last Name:BOIVIN PACKARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5601
Mailing Address - Country:US
Mailing Address - Phone:207-743-7075
Mailing Address - Fax:
Practice Address - Street 1:29 MARION AVE
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5601
Practice Address - Country:US
Practice Address - Phone:207-743-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2717225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant