Provider Demographics
NPI:1477823425
Name:BOLASKI, ERIN C (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:C
Last Name:BOLASKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:C
Other - Last Name:GALLANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:150 MIDWAY RD
Mailing Address - Street 2:SUITE 173
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5710
Mailing Address - Country:US
Mailing Address - Phone:401-942-3343
Mailing Address - Fax:401-942-3733
Practice Address - Street 1:150 MIDWAY RD
Practice Address - Street 2:SUITE 173
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5710
Practice Address - Country:US
Practice Address - Phone:401-942-3343
Practice Address - Fax:401-942-3733
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01267225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist