Healthcare Provider Details

I. General information

NPI: 1457298598
Provider Name (Legal Business Name): PAIGE AUTUMN BOLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12319 HIGHLAND RD STE 301
HARTLAND MI
48353-2946
US

IV. Provider business mailing address

27965 PONTIAC TRL
SOUTH LYON MI
48178-9238
US

V. Phone/Fax

Practice location:
  • Phone: 248-714-8445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: