Individual
KIMBERLY BOLDUC I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9280 IOAMOSA CT, ALTA LOMA, CA 91737-2162
(909) 210-5457
Mailing address
9280 IOAMOSA CT, ALTA LOMA, CA 91737-2162
(909) 210-5457
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA854
CA
Other
Enumeration date
01/28/2016
Last updated
01/28/2016
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