Individual
KAREN BOLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1432 LAFAYETTE LN, MARIETTA, GA 30068-2124
(770) 403-5651
Mailing address
1432 LAFAYETTE LN, MARIETTA, GA 30068-2124
(770) 403-5651
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT001099
GA
225X00000X
Occupational Therapist
1702630
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000759976C
—
GA
Enumeration date
12/28/2006
Last updated
01/31/2017
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