Provider Demographics
NPI:1700935350
Name:BOELIG, LORI NADINE
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:NADINE
Last Name:BOELIG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:NADINE
Other - Last Name:CICERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 PILLSBURY RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3221
Mailing Address - Country:US
Mailing Address - Phone:603-434-9526
Mailing Address - Fax:603-434-8998
Practice Address - Street 1:36 CLINTON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2359
Practice Address - Country:US
Practice Address - Phone:603-271-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH113225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist