Individual
MS. MARY LEE BOESEWETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5000 ROCKSIDE RD STE 500, INDEPENDENCE, OH 44131-2178
(216) 459-2846
(216) 901-2803
Mailing address
1396 BOBBY LN, WESTLAKE, OH 44145-1985
(440) 808-9209
(216) 901-2803
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT000492
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217474
ANTHEM BLUE CROSS AND BLU
OH
05
—
0842995
—
OH
01
—
11576182
CAQH
OH
Enumeration date
08/03/2006
Last updated
11/24/2015
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