Individual
CASEY ERIK BOOMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
1440 168TH AVE, SAN LEANDRO, CA 94578-2409
(510) 481-8575
Mailing address
1141 CATALINA DR # 273, LIVERMORE, CA 94550-5928
(925) 447-2130
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8035
CA
Other
Enumeration date
05/30/2007
Last updated
07/08/2007
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