Individual
JENNIFER LEIGHT BOLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
915 GLYNN SPRINGS DR, WILLIAMSBURG, VA 23188-2832
(757) 206-6347
Mailing address
915 GLYNN SPRINGS DR, WILLIAMSBURG, VA 23188-2832
(757) 206-6347
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000679
VA
Other
Enumeration date
12/13/2010
Last updated
12/13/2010
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