Individual
MR. PAUL ALLEN BOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
34 DUNN LN, MOUNTAIN HOME, AR 72653-8663
(870) 425-5597
(870) 425-5592
Mailing address
2805 MID CITIES DR, BENTONVILLE, AR 72712-4270
(870) 404-1046
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR411
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124621721
—
AR
Enumeration date
02/06/2007
Last updated
01/14/2017
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