Individual
LASHASTA K BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 HALLIBURTON ST, RIPLEY, TN 38063-2011
(731) 635-5180
Mailing address
245 MURDOCK CV, RIDGELY, TN 38080-1509
(731) 259-7738
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3767
TN
Other
Enumeration date
03/21/2023
Last updated
03/21/2023
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