Provider Demographics
NPI:1033678958
Name:BUBOLTZ, MONICA R
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:R
Last Name:BUBOLTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-1933
Mailing Address - Country:US
Mailing Address - Phone:507-217-6016
Mailing Address - Fax:
Practice Address - Street 1:614 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1933
Practice Address - Country:US
Practice Address - Phone:507-217-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, BlindGroup - Multi-Specialty
No225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training ProviderGroup - Multi-Specialty