Individual
ASHLEY BOLDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 1ST ST, OCONTO, WI 54153-1117
(920) 834-4575
Mailing address
4220 PITTCO RD, GREEN BAY, WI 54313-8757
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4648-27
WI
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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