Provider Demographics
NPI:1417457086
Name:BOLDEN, ROSEMARY CHERIAN (MS)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:CHERIAN
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 CHURCH WAY
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4002
Mailing Address - Country:US
Mailing Address - Phone:703-509-9195
Mailing Address - Fax:
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DR STE 2119
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4511
Practice Address - Country:US
Practice Address - Phone:571-423-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001238225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist