Individual
BRYAN BOARDSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MOT
Contact information
Practice address
815 W TOWER PARK DR, WATERLOO, IA 50701-9026
(319) 233-6995
(319) 233-7083
Mailing address
850 43RD AVE, SUITE 100, MOLINE, IL 61265-8401
(309) 743-2070
(309) 743-2073
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
002042
IA
225X00000X
Occupational Therapist
056-008438
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002042
IOWA PT LICENSE NUMBER
IA
Enumeration date
09/23/2008
Last updated
04/11/2012
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