Provider Demographics
NPI:1801913231
Name:BOSS, KERRY (OT)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:
Last Name:BOSS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8669 OLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8702
Mailing Address - Country:US
Mailing Address - Phone:614-854-9946
Mailing Address - Fax:
Practice Address - Street 1:990 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6283
Practice Address - Country:US
Practice Address - Phone:740-387-2900
Practice Address - Fax:740-387-2922
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT003515225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist