Provider Demographics
NPI:1700693660
Name:BOLLMAN, JEREMY PAUL (OTD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:PAUL
Last Name:BOLLMAN
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1310
Mailing Address - Country:US
Mailing Address - Phone:502-762-4410
Mailing Address - Fax:
Practice Address - Street 1:2152 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1622
Practice Address - Country:US
Practice Address - Phone:502-499-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY296740225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand