Provider Demographics
NPI:1992319453
Name:HARBOLD, SHOLYNN RAE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SHOLYNN
Middle Name:RAE
Last Name:HARBOLD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 TEKELEY LANE
Mailing Address - Street 2:
Mailing Address - City:RAMEY
Mailing Address - State:PA
Mailing Address - Zip Code:16671
Mailing Address - Country:US
Mailing Address - Phone:412-622-4141
Mailing Address - Fax:
Practice Address - Street 1:203 TEKELEY LANE
Practice Address - Street 2:
Practice Address - City:RAMEY
Practice Address - State:PA
Practice Address - Zip Code:16671
Practice Address - Country:US
Practice Address - Phone:412-622-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007047224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant