Provider Demographics
NPI:1669731568
Name:BOATNER, JERRI L
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:L
Last Name:BOATNER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-2832
Mailing Address - Country:US
Mailing Address - Phone:405-432-3115
Mailing Address - Fax:
Practice Address - Street 1:16820 STATE HIGHWAY 9 E
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-5220
Practice Address - Country:US
Practice Address - Phone:918-452-3335
Practice Address - Fax:918-452-3939
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor