Provider Demographics
NPI:1518773407
Name:FRIMPONG-BOATENG, KWAKU
Entity type:Individual
Prefix:
First Name:KWAKU
Middle Name:
Last Name:FRIMPONG-BOATENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROATH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3162
Mailing Address - Country:US
Mailing Address - Phone:508-933-7402
Mailing Address - Fax:
Practice Address - Street 1:6 ROATH ST APT 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-3162
Practice Address - Country:US
Practice Address - Phone:508-933-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15502225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist