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General NPI Number Information
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NPI Number | 1225270630
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Entity Type | Individual
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Provider Name | GENEVA MICHELLE BOLEN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 439 CHANNEL RD STE 102
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City | LAKE WYLIE
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State | SC
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Zip | 29710-6101
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Country | US
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Telephone | 803-746-7800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 412313 SUITE 102
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City | BOSTON
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State | MA
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Zip | 02241-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4484
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License Number State | SC
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