Provider Demographics
NPI:1730597535
Name:BOYLAND, KRISTA MICKELLE (COTA)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MICKELLE
Last Name:BOYLAND
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 MAIN ST
Mailing Address - Street 2:SUPPLEMENTAL HEALTH CARE
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5477
Mailing Address - Country:US
Mailing Address - Phone:888-317-0494
Mailing Address - Fax:888-317-0495
Practice Address - Street 1:5570 MAIN ST
Practice Address - Street 2:SUPPLEMENTAL HEALTH CARE
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5477
Practice Address - Country:US
Practice Address - Phone:888-317-0494
Practice Address - Fax:888-317-0495
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008219224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant