Provider Demographics
NPI:1609434760
Name:BOLDUC, JAZMIN A (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JAZMIN
Middle Name:A
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTRALIA SCHOOL DISTRICT #401
Mailing Address - Street 2:2320 BORST AVENUE
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-330-7600
Mailing Address - Fax:
Practice Address - Street 1:2320 BORST AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1410
Practice Address - Country:US
Practice Address - Phone:360-330-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist