MEDICARE: JENNIFER L BOLTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist	201320005	KY

General Provider Information

NPI Number	:	1033083944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L BOLTON

Provider Business Mailing Address
First Line	:	2328 1/2 DIXIE HWY
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-2934
Country	:	US
Telephone Number	:	859-801-9716
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 1/2 DIXIE HWY
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-2934
Country	:	US
Telephone Number	:	859-801-9716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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