Boardman, Charles Holloway

Boardman, Charles Holloway is an individual health care provider with primary practice located at 619 South Marion Ave North Florida / South Georgia Veterans Health System, Lake City FL 32025. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as his primary health care specialty. Boardman, Charles Holloway can be contacted via phone (386) 755-3016.

Contact Information

Primary practice address
619 South Marion Ave North Florida / South Georgia Veterans Health System Lake City FL 32025
Phone: (386) 755-3016
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X OT14416FL Florida

Profile Details

NPI number 1164417895
LBN Legal business name Boardman, Charles Holloway
Credentials Registered Occupational Therapist (OTR)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 19th, 2005
Last updated Feb 25th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164417895 NPPES
Florida Other OT14416FL FLORIDA DEPARTMENT OF HEALTH
Florida Other AA499343 FLORIDA DEPARTMENT OF HEALTH

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