Provider Demographics
NPI:1225298359
Name:BOLESTA, CHERYL MARIE (MS OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:MARIE
Last Name:BOLESTA
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:165 S MEMORIAL HWY
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:TRUCKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1418
Mailing Address - Country:US
Mailing Address - Phone:570-696-2359
Mailing Address - Fax:570-696-2367
Practice Address - Street 1:165 S MEMORIAL HWY
Practice Address - Street 2:SUITE 2C
Practice Address - City:TRUCKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18708-1418
Practice Address - Country:US
Practice Address - Phone:570-696-2359
Practice Address - Fax:570-696-2367
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010190225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist