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General NPI Number Information
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NPI Number | 1043817240
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Entity Type | Individual
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Provider Name | ERIC J BOOTMAN
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Gender | Male
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 6225 SMITH AVE STE 1001A
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City | BALTIMORE
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State | MD
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Zip | 21209-3626
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Country | US
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Telephone | 482-487-7576
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Fax |
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Provider Business Mailing Address
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Address Line | 56 HIGH ST
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City | ANDOVER
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State | MA
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Zip | 01810-3529
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Country | US
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Telephone | 978-409-5360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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