Basic Information
| Provider Information | |||||||||
| NPI: | 1770633448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOHER | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | OT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HARDER | ||||||||
| OtherFirstName: | KRISTIN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12727 KIMBERLEY LN STE 104 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770244060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133659338 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12727 KIMBERLEY LN STE 104 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770244060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133659338 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 110630 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.