Provider Demographics
NPI:1861634420
Name:BOLING, SHELLEY (OTR)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BOLING
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE C124
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7018 HAWAII KAI DR
Practice Address - Street 2:SUITE 504
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-4150
Practice Address - Country:US
Practice Address - Phone:808-596-4650
Practice Address - Fax:808-596-4651
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI386225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI386OtherOT REGISTRATION