Basic Information
| Provider Information | |||||||||
| NPI: | 1205281466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOEHME | ||||||||
| FirstName: | GEOFFREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 914 KINGS BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335737009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862146444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5535 S WILLIAMSON BLVD STE 774 | ||||||||
| Address2: | |||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321288321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003307711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2016 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 3275 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.