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General NPI Number Information
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NPI Number | 1669798153
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Entity Type | Individual
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Provider Name | MADELAINE C BODHOLDT OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 04/09/2010
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Provider Practice Location Address
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Address Line | 150 W HUFFAKER LANE STE 105
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City | RENO
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State | NV
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Zip | 89511-2092
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Country | US
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Telephone | 775-852-4342
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Fax | 775-852-9136
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Provider Business Mailing Address
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Address Line | 7200 LINGFIELD DRIVE
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City | RENO
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State | NV
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Zip | 89502-9661
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Country | US
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Telephone | 775-857-7854
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0012
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License Number State | NV
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