Provider Demographics
NPI:1336340793
Name:BOATNER, EMILY BURKHALTER (M ED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:BURKHALTER
Last Name:BOATNER
Suffix:
Gender:F
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 AIRPORT BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8639
Mailing Address - Country:US
Mailing Address - Phone:850-723-9636
Mailing Address - Fax:
Practice Address - Street 1:1510 AIRPORT BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8639
Practice Address - Country:US
Practice Address - Phone:850-723-9636
Practice Address - Fax:888-282-6913
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1107556103K00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist