Provider Demographics
NPI:1336765627
Name:BOOHER, TAYLOR (RDN)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:
Last Name:BOOHER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 DORCHESTER DR APT 112
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4024
Mailing Address - Country:US
Mailing Address - Phone:517-898-8497
Mailing Address - Fax:
Practice Address - Street 1:603 DORCHESTER DR APT 112
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4024
Practice Address - Country:US
Practice Address - Phone:517-898-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered