Individual
EMILY BOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
1111 44TH RD STE 402, LONG ISLAND CITY, NY 11101-5115
(518) 915-5105
Mailing address
4209 23RD AVE APT 2F, ASTORIA, NY 11105-1530
(518) 915-5105
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
020676
NY
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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