MEDICARE: KARI MARIE BOEHMKER

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	2255A2300X	Athletic Trainer	AT004580	OH

General Provider Information

NPI Number	:	1265143010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI MARIE BOEHMKER

Provider Business Mailing Address
First Line	:	3581 DORSET CT
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41015-3500
Country	:	US
Telephone Number	:	513-917-4107
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 BETHEL NEW RICHMOND RD
Second Line	:
City	:	NEW RICHMOND
State	:	OH
Zip	:	45157-8530
Country	:	US
Telephone Number	:	513-553-3191
Fax Number	:	513-553-2531

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

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/12/2022

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