Individual
KIMBERLY BOAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3520 S NOVA RD, PORT ORANGE, FL 32129-3725
(386) 281-8193
Mailing address
3520 S NOVA RD, PORT ORANGE, FL 32129-3725
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18904
FL
Other
Enumeration date
04/14/2022
Last updated
03/31/2023
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