Provider Demographics
NPI:1437563087
Name:BOLDEN, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 W RUSSELL RD
Mailing Address - Street 2:SUITE NUMBER 170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1888
Mailing Address - Country:US
Mailing Address - Phone:702-896-8400
Mailing Address - Fax:702-791-5600
Practice Address - Street 1:6825 W RUSSELL RD
Practice Address - Street 2:SUITE NUMBER 170
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1888
Practice Address - Country:US
Practice Address - Phone:702-896-8400
Practice Address - Fax:702-791-5600
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0575225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist