Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Charles Holloway Boardman IV, OTR

Individual provider Occupational Therapist · NPI 1164417895

Mr. Charles Holloway Boardman IV, OTR is an Occupational Therapist in Lake City, Florida. Licensed in Florida. Registered with an NPI since 2005.

Licensed in
FL
In the registry since
2005
What do these letters mean?
OTR — Occupational Therapist, Registered
A nationally registered occupational therapist.

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Practice location Address checks out

619 S Marion Ave North Florida / South Georgia Veterans Health System
Lake City, FL 32025
Phone: (386) 755-3016
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence OT14416FL (FL)

Record details

NPI number1164417895
Entity typeIndividual (Type 1)
GenderMale
Credentials OTR
Sole proprietorNo
NPI enumeratedSeptember 19, 2005
Last updated in NPPESFebruary 25, 2012

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