Provider Demographics
NPI:1447405642
Name:BOLANOS, MARILYN C
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:C
Last Name:BOLANOS
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 1:1104 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-3419
Mailing Address - Country:US
Mailing Address - Phone:718-530-4708
Mailing Address - Fax:914-231-6371
Practice Address - Street 1:1104 HUNTERS RUN
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-3419
Practice Address - Country:US
Practice Address - Phone:718-530-4708
Practice Address - Fax:914-231-6371
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011146225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics