Healthcare Provider Details

I. General information

NPI: 1699306852
Provider Name (Legal Business Name): AMY ELIZABETH BOLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH ASHBROOK

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4968 GLENWAY AVE
CINCINNATI OH
45238-3902
US

IV. Provider business mailing address

4974 RELLEUM AVE
CINCINNATI OH
45238-3806
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-6575
  • Fax:
Mailing address:
  • Phone: 614-736-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: