=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215331624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN BOLTON SCHOOL PSYCHOLOGIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2014
-----------------------------------------------------
Last Update Date | 10/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8916 FONTAINEBLEAU TER
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45231-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-931-0712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7421 MIAMI HILLS DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45243-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-791-8775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | SP141
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------