MEDICARE: MS. MARY KATHRYN BOETTNER

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	103K00000X	Behavior Analyst	BH004007	PA

General Provider Information

NPI Number	:	1801369566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY KATHRYN BOETTNER

Provider Business Mailing Address
First Line	:	2050 VOORHEES TOWN CTR
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-1910
Country	:	US
Telephone Number	:	856-346-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 VOORHEES TOWN CTR
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-1910
Country	:	US
Telephone Number	:	856-346-0005
Fax Number	:

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

Provider Enumeration Date	:	01/05/2019
Last Update Date	:	08/03/2023

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