Provider Demographics
NPI:1134518848
Name:BOOHER, NICOLE SUMMERS
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SUMMERS
Last Name:BOOHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5404 PINCUSHION DAISY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2216
Mailing Address - Country:US
Mailing Address - Phone:505-385-5481
Mailing Address - Fax:
Practice Address - Street 1:302 MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-2216
Practice Address - Country:US
Practice Address - Phone:512-501-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology