Provider Demographics
NPI:1700200581
Name:BOLLENBACHER, LINDA I
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BOLLENBACHER
Suffix:I
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 1:11400 COUNTY ROAD 46
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9578
Mailing Address - Country:US
Mailing Address - Phone:419-217-4085
Mailing Address - Fax:
Practice Address - Street 1:11400 COUNTY ROAD 46
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9578
Practice Address - Country:US
Practice Address - Phone:419-217-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 376J00000X
OHOTA01642224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant