Provider Demographics
NPI:1235419292
Name:BOLANDER, SARAH ELYSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELYSE
Last Name:BOLANDER
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 1:133 COLONIAL DR
Mailing Address - Street 2:APT 402
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-2907
Mailing Address - Country:US
Mailing Address - Phone:989-450-2543
Mailing Address - Fax:
Practice Address - Street 1:133 COLONIAL DR
Practice Address - Street 2:APT 402
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-2907
Practice Address - Country:US
Practice Address - Phone:989-450-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2193225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist