Basic Information
| Provider Information | |||||||||
| NPI: | 1043738669 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYTER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2707 ASHLEY ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042654 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1829 E FRANKLIN ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199683456 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2017 | ||||||||
| LastUpdateDate: | 11/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 10782 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 10782 | 01 | NC | NORTH CAROLINA BOARD OF OCCUPATIONAL THERAPY | OTHER |