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NPI Code Detail

MEDICARE: MS. JAZMIN A BOLDUC OTR/L

MEDICARE: MS. JAZMIN A BOLDUC 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 Therapist

General Provider Information

NPI Number : 1609434760
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JAZMIN A BOLDUC OTR/L
Provider Business Mailing Address
First Line : CENTRALIA SCHOOL DISTRICT #401
Second Line : 2320 BORST AVENUE
City : CENTRALIA
State : WA
Zip : 98531
Country : US
Telephone Number : 360-330-7600
Fax Number :
Provider Business Practice Location Address
First Line : 2320 BORST AVE
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-1410
Country : US
Telephone Number : 360-330-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2019
Last Update Date : 06/04/2019

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