Provider Demographics
NPI:1407002140
Name:BOLIN, PATRICIA KAY (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KAY
Last Name:BOLIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IL
Mailing Address - Zip Code:61931-7805
Mailing Address - Country:US
Mailing Address - Phone:217-856-2292
Mailing Address - Fax:
Practice Address - Street 1:1918 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IL
Practice Address - Zip Code:61931-7805
Practice Address - Country:US
Practice Address - Phone:217-856-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001183224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant