MEDICARE: MRS. MARY ELIZABETH BOLGER OTRL

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	171W00000X	Contractor	KY-R2141	KY
2	225X00000X	Occupational Therapist	R2141	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285838490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ELIZABETH BOLGER OTRL

Provider Business Mailing Address
First Line	:	1 SPERTI DR
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-9654
Country	:	US
Telephone Number	:	859-344-9322
Fax Number	:	859-344-9332

Provider Business Practice Location Address
First Line	:	2003 PIECK DR
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41011-2627
Country	:	US
Telephone Number	:	859-653-1927
Fax Number	:

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	04/20/2016

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