Provider Demographics
NPI:1386274983
Name:BOEHMER, JENNIFER NOELLE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NOELLE
Last Name:BOEHMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 CONCERTO CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3304
Mailing Address - Country:US
Mailing Address - Phone:937-321-3564
Mailing Address - Fax:
Practice Address - Street 1:310 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1410
Practice Address - Country:US
Practice Address - Phone:606-546-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer