Healthcare Provider Details

I. General information

NPI: 1285876581
Provider Name (Legal Business Name): CHRISTOPHER DONALD BOLING OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 KAPIOLANI BLVD STE C124
HONOLULU HI
96813-6013
US

IV. Provider business mailing address

66-932 KUEWA DR
WAIALUA HI
96791-9719
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-4650
  • Fax: 808-596-4651
Mailing address:
  • Phone: 808-637-2000
  • Fax: 808-637-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number385
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number385
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: