MEDICARE: ALICE WILLOW BOOTH

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	:	1366253874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE WILLOW BOOTH

Provider Business Mailing Address
First Line	:	5540 PARK BLVD N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 PARK BLVD N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3326
Country	:	US
Telephone Number	:	727-225-1669
Fax Number	:

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

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	10/30/2025

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Directions to “ ALICE WILLOW BOOTH ” Practice Location

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