Individual
LOIS BOOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
336 S 10TH ST, MONTROSE, CO 81401-4934
(970) 249-1412
Mailing address
PO BOX 102, NATURITA, CO 81422-0102
(970) 765-4533
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
105065-4201
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
999000021033 D1240
—
UT
Enumeration date
01/26/2007
Last updated
07/12/2021
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