Individual
KAYLENE MARY BOLLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3416 AMERICAN RIVER DR, SACRAMENTO, CA 95864-5753
(916) 979-0497
Mailing address
1100 N ST, SACRAMENTO, CA 95814-5627
(650) 465-1292
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
446886
CA
Other
Enumeration date
03/16/2022
Last updated
03/16/2022
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