MR. CHARLES HOLLOWAY BOARDMAN IV (NPI# 1164417895) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164417895 |
| Entity Type | Individual |
| Full Name | MR. CHARLES HOLLOWAY BOARDMAN IV |
| Credential | OTR |
| Practice Address |
619 South Marion Ave North Florida / South Georgia Veterans Health System Lake City FL 32025 |
| Mailing Address |
355 Sw Sweetbreeze Dr Lake City FL 32024-3698 |
| Practice Telephone | 3867553016 |
| Mailing Telephone | 3867553016 |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2012-02-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225X00000X | Occupational Therapist | OT14416FL | FL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NBCOT | AA499343 | 01 | |
| FL | FLORIDA DEPARTMENT OF HEALTH | OT14416FL | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720135643 | Charles Roy Boardman | Registered Nurse | 4226 Ne Grand Ave, Portland, OR 97211-3411 | 2007-01-04 |
| 1801176722 | Charles Alan Boardman | Social Worker | 303 S Broadway, 3rd Floor, Tarrytown, NY 10591-5413 | 2011-08-23 |
| Street Address |
619 SOUTH MARION AVE NORTH FLORIDA / SOUTH GEORGIA VETERANS HEALTH SYSTEM |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649303124 | Ann M Barber | Internal Medicine | 619 South Marion Ave, Vamc - Lake City, Lake City, FL 32025-5808 | 2007-03-13 |
| 1114028909 | Eunice Luvis | Pharmacist | 619 South Marion Ave, Lake City, FL 32025 | 2006-09-26 |
| 1528169372 | Eddie James Hukle | Pharmacist | 619 South Marion Ave, Lake City, FL 32056-9000 | 2006-09-26 |
| 1417050386 | Haleem Jacob Moussa | Registered Nurse | 619 South Marion Ave, Lake City, FL 32025 | 2006-09-06 |
| 1184639981 | Kathleen Erina Mcnamara | Emergency Medicine | 619 South Marion Ave, Lake City, FL 32025 | 2006-07-30 |
| 1497719983 | Raul Edgardo Medina | Family Medicine | 619 South Marion Ave, Va Hospital, Lake City, FL 32025 | 2006-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801438353 | Jennifer Bennett | Pharmacist | 347 Sw Main Blvd Suite 102, Lake City, FL 32025 | 2019-10-16 |
| 1700352838 | Robert J Sansouci IIi IIi | Physical Therapy Assistant | 560 Sw Mcfarlane Ave, Lake City, Fl, 32025, Lake City, FL 32025 | 2018-10-16 |
| 1316442783 | Emily Bailey | Developmental Therapist | 2126 Sw Sisters Welcome Rd, Lake City, FL 32025 | 2018-03-28 |
| 1811446370 | Michelle Hart | Behavioral Analyst | 260 S. Marion Avenue, Bldg. A, Suite 135, Lake City, FL 32025 | 2016-09-26 |
| 1922467646 | Irene Aponte Moreno | Nurse Practitioner | 440 Sw Perimeter Glen, Lake City, FL 32025 | 2016-02-23 |
| 1093186777 | Decarlos Scippio | Counselor | 619 Sw Baya Drive Suite 102, Lake City, FL 32025 | 2015-10-07 |
| 1497132476 | Jamecia Legree | Registered Nurse | 800 Sw Symphony Loop, Bldg 15 Apt 204, Lake City, FL 32025 | 2015-04-29 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1598174344 | Karen Mcdonald | Developmental Therapist | 4523 Se County Road 252, Lake City, FL 32025 | 2014-08-06 |
| 1275944126 | Mohammad Ali Faisal Mdpa | Specialist | 1283 Sw State Rd 47, Ste 104, Lake City, FL 32025 | 2014-05-14 |
| Find all providers in zip 32025 | ||||
| Taxonomy Code | 225X00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Occupational Therapist |
| An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life. |
| Notes: Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851801765 | Stephanie Jo Nogle | Occupational Therapist | Brooks Americare: 4251 Nw American Ln, #103, Lake City, FL 32055 | 2017-10-05 |
| 1821474115 | Pro-motion Physical Therapy of Florence, Sc, LLC | Occupational Therapist | 148 B Sauls Street, Lake City, SC 29560 | 2015-08-10 |
| 1164763843 | Seema Kunder | Occupational Therapist | 659 Sw Dexter Cir, Apt 105, Lake City, FL 32025-5681 | 2013-03-06 |
| 1710256078 | Kaci J Roller | Occupational Therapist | 10757 W Rosted Rd, Lake City, MI 49651-8203 | 2011-12-15 |
| 1518236868 | Marianne Totton | Occupational Therapist | 5485 S Riverview Dr, Lake City, MI 49651-8656 | 2011-12-15 |
| 1902184468 | Amy Mccall | Occupational Therapist | 40 Godfrey Rd, Lake City, PA 16423-2108 | 2011-08-01 |
| 1568699056 | Hazel Shipman | Occupational Therapist | 318 B Moore Street, Lake City, SC 29560-2551 | 2009-06-11 |
| 1265603153 | Erin Lynn Hoeksema | Occupational Therapist | 451 Lakeside Dr, Lake City, PA 16423-1855 | 2008-03-18 |
| 1679756035 | Megan Markham Hansen | Occupational Therapist | 220 Se Park Ter, Lake City, FL 32025-4487 | 2007-12-07 |
| 1396965752 | Chris Klein Otr Plc | Occupational Therapist | 805 Mitchell St, Lake City, MI 49651 | 2007-04-26 |
| Find all providers in LAKE CITY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.