MEDICARE: KELLY BOUSCAREN CRT

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	227800000X	Certified Respiratory Therapist	L02913	MD

General Provider Information

NPI Number	:	1225579717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BOUSCAREN CRT

Provider Business Mailing Address
First Line	:	732 CINDY LN
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-7656
Country	:	US
Telephone Number	:	443-834-9751
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 CINDY LN
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-7656
Country	:	US
Telephone Number	:	443-834-9751
Fax Number	:

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

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	03/16/2017

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