Renee L Bolduc, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

46TA09075800 Issued in NJ

Practice address

199 Bergen Tpke Apt 3L
Ridgefield Park, NJ 07660-2342

Phone

(201) 641-4832

NPI assigned

Jul 16, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429920000000",
    "number": "1790984136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 BERGEN TPKE APT 3L",
            "city": "RIDGEFIELD PARK",
            "state": "NJ",
            "postal_code": "076602342",
            "telephone_number": "201-641-4832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 BERGEN TPKE APT 3L",
            "city": "RIDGEFIELD PARK",
            "state": "NJ",
            "postal_code": "076602342",
            "telephone_number": "201-641-4832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDUC",
        "first_name": "RENEE",
        "middle_name": "L",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-16",
        "last_updated": "2015-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NJ",
            "license": "46TA09075800",
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NY",
            "license": "007426-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth August, MD
• Aida Awad, MD
• Iyad Baker, M.D.
• Bergen Pediatric Dental, LLC
• Kristin Blankinship, PHARMD
• Thomas Bonk, ATC/L
• Stephanie Smith Bowers, NP
• Rhonda Brown, MSW
• Paris Castro
• Monique Charles

• Occupational Therapy Assistant in Ridgefield Park, NJ
• Providers in Ridgefield Park, NJ by specialty
• Occupational Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.