MEDICARE: ERIC J BOOTMAN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1043817240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC J BOOTMAN

Provider Business Mailing Address
First Line	:	56 HIGH ST
Second Line	:
City	:	ANDOVER
State	:	MA
Zip	:	01810-3529
Country	:	US
Telephone Number	:	978-409-5360
Fax Number	:

Provider Business Practice Location Address
First Line	:	6225 SMITH AVE STE 1001A
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-3626
Country	:	US
Telephone Number	:	482-487-7576
Fax Number	:

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

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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