MEDICARE: RACHEL LYNN BOEHMERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BA-553	HI

General Provider Information

NPI Number	:	1801413190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LYNN BOEHMERT

Provider Business Mailing Address
First Line	:	60 N BERETANIA ST APT 1406
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-4757
Country	:	US
Telephone Number	:	801-810-8346
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 N BERETANIA ST APT 1406
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-4757
Country	:	US
Telephone Number	:	801-810-8346
Fax Number	:	808-490-0497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	01/12/2025

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