Individual
MR. CHARLES HOLLOWAY BOARDMAN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT14416FL
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA499343
NBCOT
—
01
—
OT14416FL
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
09/19/2005
Last updated
02/25/2012
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