Provider Demographics
NPI:1861891582
Name:BOOHER, MARGARET SUZANNE
Entity type:Individual
Prefix:MISS
First Name:MARGARET
Middle Name:SUZANNE
Last Name:BOOHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 BITTERSWEET BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5261
Mailing Address - Country:US
Mailing Address - Phone:904-742-6045
Mailing Address - Fax:
Practice Address - Street 1:1008 BITTERSWEET BRANCH CT
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-5261
Practice Address - Country:US
Practice Address - Phone:904-742-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer