Provider Demographics
NPI:1205243185
Name:BOOM, TONI
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:BOOM
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 1:1238 S ST
Mailing Address - Street 2:SOCIETY FOR THE BLIND
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-7112
Mailing Address - Country:US
Mailing Address - Phone:916-452-8271
Mailing Address - Fax:
Practice Address - Street 1:1238 S ST
Practice Address - Street 2:SOCIETY FOR THE BLIND
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-7112
Practice Address - Country:US
Practice Address - Phone:916-452-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-12
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9263225X00000X, 225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision