Basic Information
| Provider Information | |||||||||
| NPI: | 1023492923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLTON-DORTONE | ||||||||
| FirstName: | KIERSTEN | ||||||||
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| OtherLastName: | BOLTON | ||||||||
| OtherFirstName: | KIERSTEN | ||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 907 WESTFIELD RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190643834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109087664 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 PLUSH MILL RD | ||||||||
| Address2: | |||||||||
| City: | WALLINGFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190866040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108590002 | ||||||||
| FaxNumber: | 6106729936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2015 | ||||||||
| LastUpdateDate: | 07/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC013138 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.