Provider Demographics
NPI:1679155154
Name:BOLT, LEANNE PARTRIDGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:PARTRIDGE
Last Name:BOLT
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 1:2775 CEZANNE LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7174
Mailing Address - Country:US
Mailing Address - Phone:404-395-0937
Mailing Address - Fax:
Practice Address - Street 1:2775 CEZANNE LN
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7174
Practice Address - Country:US
Practice Address - Phone:404-395-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist