Provider Demographics
NPI:1316659691
Name:BOLTON, JENNA MAY
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:MAY
Last Name:BOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 E REPUBLIC RD APT 7304
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6653
Mailing Address - Country:US
Mailing Address - Phone:562-235-8011
Mailing Address - Fax:
Practice Address - Street 1:6450 S BOSTON ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5336
Practice Address - Country:US
Practice Address - Phone:303-865-5302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist