Individual
MR. JACK AARON BOLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
700 RANDOLPH ST, RADFORD, VA 24141-2430
(540) 633-6533
Mailing address
700 RANDOLPH ST, RADFORD, VA 24141-2430
(540) 633-6533
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000124
VA
Other
Enumeration date
03/09/2010
Last updated
03/09/2010
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