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NPI Code Detail

MEDICARE: LORRIE ANN BOLEN COTA/L

MEDICARE: LORRIE ANN BOLEN COTA/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
1224Z00000XOccupational Therapy AssistantC1033WV
2224Z00000XOccupational Therapy AssistantOTA-00775OH

General Provider Information

NPI Number : 1487754123
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORRIE ANN BOLEN COTA/L
Provider Business Mailing Address
First Line : 19 BARBARA AVE
Second Line :
City : MC DERMOTT
State : OH
Zip : 45652-9046
Country : US
Telephone Number : 740-259-5176
Fax Number :
Provider Business Practice Location Address
First Line : 200 ELIZABETH ST
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-2119
Country : US
Telephone Number : 304-348-7740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2006
Last Update Date : 07/08/2007

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