Provider Demographics
NPI:1114696457
Name:BOLDUC, JENNIFER KAREN (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAREN
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6623 63RD TER E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-8042
Mailing Address - Country:US
Mailing Address - Phone:941-350-0629
Mailing Address - Fax:
Practice Address - Street 1:700 JOHN RINGLING BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-1542
Practice Address - Country:US
Practice Address - Phone:941-365-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4244225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist