Janie Boulware

Individual provider Active NPI Day Training/Habilitation Specialist · Macclenny, FL

NPI 1306858600 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1306858600
Entity type
Individual (NPI type 1)
Primary specialty
Day Training/Habilitation Specialist 373H00000X
Practice address
706 Shortputt Dr
Macclenny, FL 32063-4319
Phone
(904) 265-0340
Fax
(904) 265-1906
NPI assigned
Aug 13, 2006
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Day Training/Habilitation Specialist 373H00000X Yes

Addresses

Primary practice location

706 Shortputt Dr
Macclenny, FL 32063-4319

Mailing address

706 Shortputt Dr
Macclenny, FL 32063-4319
Phone (904) 265-0340

Other providers in Macclenny, FL

All providers in Macclenny, FL · Day Training/Habilitation Specialist in Florida

Sources for this page

Verify at the official NPI Registry.