Provider Demographics
NPI:1184753550
Name:BOMER, JANE (MOT, OTR)
Entity type:Individual
Prefix:MISS
First Name:JANE
Middle Name:
Last Name:BOMER
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:RONZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT OTR
Mailing Address - Street 1:4015 INTERSTATE 45 N
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4901
Mailing Address - Country:US
Mailing Address - Phone:936-522-4731
Mailing Address - Fax:936-522-4737
Practice Address - Street 1:4015 INTERSTATE 45 N
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4901
Practice Address - Country:US
Practice Address - Phone:936-522-4731
Practice Address - Fax:936-522-4737
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K7551Medicare PIN