Provider Demographics
NPI:1801011838
Name:BOLAND, JENNIFER K (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:BOLAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 MOOSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02032-1430
Mailing Address - Country:US
Mailing Address - Phone:508-734-5379
Mailing Address - Fax:
Practice Address - Street 1:39 SALISBURY ST
Practice Address - Street 2:DIVERSIFIED STAFFING GROUP
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-3160
Practice Address - Country:US
Practice Address - Phone:603-624-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist