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NPI Code Detail

MEDICARE: SPENSER BOLTE

MEDICARE:   SPENSER  BOLTE
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1407229966
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPENSER BOLTE
Provider Business Mailing Address
First Line : 4050 N WOODED HOLLOW DR
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72704-5415
Country : US
Telephone Number : 870-577-9392
Fax Number :
Provider Business Practice Location Address
First Line : 907 S DETROIT AVE
Second Line : SUITE 1140
City : TULSA
State : OK
Zip : 74120-4205
Country : US
Telephone Number : 870-577-9392
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2015
Last Update Date : 11/05/2015

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Directions to “ SPENSER BOLTE ” Practice Location

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