Individual
DR. JACQUELYN ANDERSON BOLDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, OT
Contact information
Practice address
618 KELLOGG ST, PLYMOUTH, MI 48170-1707
(734) 207-5372
(734) 207-5372
Mailing address
618 KELLOGG ST, PLYMOUTH, MI 48170-1707
(734) 207-5372
(734) 207-5372
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
52201007062
MI
Other
Enumeration date
01/18/2012
Last updated
01/18/2012
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