Active NPI
Myra Boerner, OTR
- Occupational Therapist
- Acworth, GA
National Provider Identifier
1528294592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 000310
- Practice address
- 1618 Clark Lake Dr NW
Acworth, GA 30102-7906 - Phone
- (770) 794-8526
- NPI assigned
- Jun 4, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 000310 | GA | Primary |
Addresses
Primary practice location
1618 Clark Lake Dr NW
Acworth, GA 30102-7906
Mailing address
1618 Clark Lake Dr NW
Acworth, GA 30102-7906
Phone (770) 794-8526
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000310 | GA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244073600000",
"number": "1528294592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1618 CLARK LAKE DR NW",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301027906",
"telephone_number": "770-794-8526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1618 CLARK LAKE DR NW",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301027906",
"telephone_number": "770-794-8526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOERNER",
"first_name": "MYRA",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-04",
"last_updated": "2009-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "GA",
"license": "000310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.