Healthcare Provider Details

I. General information

NPI: 1710214804
Provider Name (Legal Business Name): ANDREA BOLTON OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA KAPLON OTD, OTR/L

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 UNIVERSITY BLVD STE E2C
NORTH CHARLESTON SC
29406-9149
US

IV. Provider business mailing address

9225 UNIVERSITY BLVD STE E2C
NORTH CHARLESTON SC
29406-9149
US

V. Phone/Fax

Practice location:
  • Phone: 843-569-4546
  • Fax: 843-569-4535
Mailing address:
  • Phone: 843-569-4546
  • Fax: 843-569-4535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3752
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: