Provider Demographics
NPI:1144695560
Name:BOLEY, HANNAH (OTL)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BOLEY
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8833
Mailing Address - Country:US
Mailing Address - Phone:812-820-7677
Mailing Address - Fax:
Practice Address - Street 1:6509 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8833
Practice Address - Country:US
Practice Address - Phone:812-820-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBOTOCT00222816225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics