MEDICARE: KENNETH BOOHER M.S., F-AAA

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	231H00000X	Audiologist	AY193	FL

General Provider Information

NPI Number	:	1841497062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH BOOHER M.S., F-AAA

Provider Business Mailing Address
First Line	:	821 MEDICAL CT E
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4623
Country	:	US
Telephone Number	:	352-726-3131
Fax Number	:	888-491-4391

Provider Business Practice Location Address
First Line	:	821 MEDICAL CT E
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4623
Country	:	US
Telephone Number	:	352-726-3131
Fax Number	:	888-491-4367

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	06/29/2021

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