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General NPI Number Information
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NPI Number | 1700693660
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Entity Type | Individual
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Provider Name | JEREMY PAUL BOLLMAN OTD
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Gender | Male
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Dates
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Enumeration Date | 12/14/2024
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 2152 S HURSTBOURNE PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40220-1622
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Country | US
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Telephone | 502-499-0107
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Fax |
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Provider Business Mailing Address
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Address Line | 306 BIRCH AVE
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City | LA GRANGE
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State | KY
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Zip | 40031-1310
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Country | US
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Telephone | 502-762-4410
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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 | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 296740
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License Number State | KY
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