Charles Holloway Boardman IV, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT14416FL Issued in FL

Practice address

619 South Marion Ave
North Florida / South Georgia Veterans Health System
Lake City, FL 32025

Phone

(386) 755-3016

NPI assigned

Sep 19, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330128000000",
    "number": "1164417895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 SW SWEETBREEZE DR",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320243698",
            "telephone_number": "386-755-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 SOUTH MARION AVE",
            "address_2": "NORTH FLORIDA / SOUTH GEORGIA VETERANS HEALTH SYSTEM",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "32025",
            "telephone_number": "386-755-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOARDMAN",
        "first_name": "CHARLES",
        "middle_name": "HOLLOWAY",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2012-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT14416FL",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "OT14416FL",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NBCOT",
            "identifier": "AA499343",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melody Sue Blankenship, RRT
• Nancy Thedis Blanton, LCSW
• Jennifer Blue
• Jean Blum, LMT
• Katie J Blunk, CTRS, CARSS II
• Karl D Bodendorfer, MD
• Reka Bodo Holland, PHARMD
• Boh Health and Education LLC
• Derral Bomar
• Patricia Bonner

• Occupational Therapist in Lake City, FL
• Providers in Lake City, FL by specialty
• Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.