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NPI Code Detail

MEDICARE: MR. EDWARD S BOLAND OTR/L

MEDICARE: MR. EDWARD S BOLAND OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XG0600XGerontology Occupational Therapist

General Provider Information

NPI Number : 1194282673
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWARD S BOLAND OTR/L
Provider Business Mailing Address
First Line : PO BOX 112173
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-8173
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2186 AMBLESIDE DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-4620
Country : US
Telephone Number : 216-791-1400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2019
Last Update Date : 02/21/2019

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