Provider Demographics
NPI:1528271210
Name:BOLEN, DAWN CHRISTINE (COTA)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:CHRISTINE
Last Name:BOLEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 N LEUTZ RD LOT 10
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-9715
Mailing Address - Country:US
Mailing Address - Phone:419-898-1088
Mailing Address - Fax:
Practice Address - Street 1:700 HELEN ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-2051
Practice Address - Country:US
Practice Address - Phone:419-547-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.02325224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant