Provider Demographics
NPI:1871558346
Name:BOAZ, MARILYN ELIZABETH (OTR CHT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:ELIZABETH
Last Name:BOAZ
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21006 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66218
Mailing Address - Country:US
Mailing Address - Phone:913-422-3863
Mailing Address - Fax:
Practice Address - Street 1:16018 W 65TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217
Practice Address - Country:US
Practice Address - Phone:913-248-1461
Practice Address - Fax:913-248-8689
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700556225X00000X
MO2006000648225X00000X
MO9511000065225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand