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NPI Code Detail

MEDICARE: MRS. GENEVA MICHELLE BOLEN OTR/L

MEDICARE: MRS. GENEVA MICHELLE BOLEN OTR/L
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
1225X00000XOccupational Therapist4484SC

General Provider Information

NPI Number : 1225270630
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GENEVA MICHELLE BOLEN OTR/L
Provider Business Mailing Address
First Line : PO BOX 412313 SUITE 102
Second Line :
City : BOSTON
State : MA
Zip : 02241-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 439 CHANNEL RD STE 102
Second Line :
City : LAKE WYLIE
State : SC
Zip : 29710-6101
Country : US
Telephone Number : 803-746-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2009
Last Update Date : 07/22/2025

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Directions to “ MRS. GENEVA MICHELLE BOLEN OTR/L” Practice Location

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