Active NPI
Paul Allen Bolt, OTR
- Occupational Therapist
- Mountain Home, AR
National Provider Identifier
1386783926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR411
- Practice address
- 34 Dunn LN
Mountain Home, AR 72653-8663 - Phone
- (870) 425-5597
- Fax
- (870) 425-5592
- NPI assigned
- Feb 6, 2007
- Last updated
- Jan 14, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTR411 | AR | Primary |
Addresses
Primary practice location
34 Dunn LN
Mountain Home, AR 72653-8663
Mailing address
2805 Mid Cities Dr
Bentonville, AR 72712-4270
Phone (870) 404-1046
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 124621721 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR411 | AR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484352000000",
"number": "1386783926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2805 MID CITIES DR",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727124270",
"telephone_number": "870-404-1046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 DUNN LN",
"city": "MOUNTAIN HOME",
"state": "AR",
"postal_code": "726538663",
"telephone_number": "870-425-5597",
"fax_number": "870-425-5592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLT",
"first_name": "PAUL",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2017-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR411",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124621721",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.