Provider Demographics
NPI:1215408570
Name:BOLEY, HEATHER (OTD, MS, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:BOLEY
Suffix:
Gender:F
Credentials:OTD, MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ARUNDEL WAY
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-3310
Mailing Address - Country:US
Mailing Address - Phone:703-608-0292
Mailing Address - Fax:
Practice Address - Street 1:515 ARUNDEL WAY
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-3310
Practice Address - Country:US
Practice Address - Phone:703-608-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist