Provider Demographics
NPI:1376573303
Name:BOLME, DEREK RICHARD (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:RICHARD
Last Name:BOLME
Suffix:
Gender:M
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 1:211 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2859
Mailing Address - Country:US
Mailing Address - Phone:319-277-3166
Mailing Address - Fax:319-266-4846
Practice Address - Street 1:211 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2859
Practice Address - Country:US
Practice Address - Phone:319-277-3166
Practice Address - Fax:319-266-4846
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01467225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist