Active NPI
Lois Boomer, OT
- Pediatric Occupational Therapist
- Montrose, CO
National Provider Identifier
1679629034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 105065-4201
- Practice address
- 336 S 10TH St
Montrose, CO 81401-4934 - Phone
- (970) 249-1412
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 105065-4201 | UT | Primary |
Addresses
Primary practice location
336 S 10TH St
Montrose, CO 81401-4934
Mailing address
PO Box 102
Naturita, CO 81422-0102
Phone (970) 765-4533
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 999000021033 D1240 | Medicaid | UT |
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 |
|---|---|---|---|
| 105065-4201 | UT | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626048000000",
"number": "1679629034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 102",
"city": "NATURITA",
"state": "CO",
"postal_code": "814220102",
"telephone_number": "970-765-4533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "336 S 10TH ST",
"city": "MONTROSE",
"state": "CO",
"postal_code": "814014934",
"telephone_number": "970-249-1412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOMER",
"first_name": "LOIS",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "UT",
"license": "105065-4201",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "999000021033 D1240",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montrose, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.