Provider Demographics
NPI:1013596287
Name:BOLIVAR, SARA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BOLIVAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 SAVOY DR APT 5110
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1036
Mailing Address - Country:US
Mailing Address - Phone:321-460-3190
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHLANDS PKWY SE STE 150
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5191
Practice Address - Country:US
Practice Address - Phone:770-433-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist