Basic Information
| Provider Information | |||||||||
| NPI: | 1730597535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYLAND | ||||||||
| FirstName: | KRISTA | ||||||||
| MiddleName: | MICKELLE | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5570 MAIN ST | ||||||||
| Address2: | SUPPLEMENTAL HEALTH CARE | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883170494 | ||||||||
| FaxNumber: | 8883170495 | ||||||||
| Practice Location | |||||||||
| Address1: | 5570 MAIN ST | ||||||||
| Address2: | SUPPLEMENTAL HEALTH CARE | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883170494 | ||||||||
| FaxNumber: | 8883170495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2014 | ||||||||
| LastUpdateDate: | 07/24/2014 | ||||||||
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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 | 224Z00000X | 008219 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.