Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023469970 |
---|---|
Provider Name | Haliee Bolling |
First Address | Shreveport, LA 71105-4002 |
Second Address | Shreveport, LA 71105-4002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 22/06/2016 |