Provider Demographics
NPI:1417715855
Name:BOOHER, OLIVIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BOOHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 SW 73RD CT APT 308
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2939
Mailing Address - Country:US
Mailing Address - Phone:954-294-0341
Mailing Address - Fax:
Practice Address - Street 1:8200 NW 27TH ST
Practice Address - Street 2:UNIT 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122
Practice Address - Country:US
Practice Address - Phone:305-591-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist