Provider Demographics
NPI:1053578724
Name:BOYD, ANGELA NICOLE (MSR, OTR/L)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:NICOLE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSR, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MARTELE CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7615
Mailing Address - Country:US
Mailing Address - Phone:864-962-6832
Mailing Address - Fax:864-963-2583
Practice Address - Street 1:11 MARTELE CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7615
Practice Address - Country:US
Practice Address - Phone:864-962-6832
Practice Address - Fax:864-963-2583
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889545700Medicaid
1487735700OtherORGANIZATIONAL NPI
SCTH1231Medicaid