Provider Demographics
NPI:1609633924
Name:BOHLAND, BRADLEY J
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:BOHLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:PAYNE
Mailing Address - State:OH
Mailing Address - Zip Code:45880-0506
Mailing Address - Country:US
Mailing Address - Phone:419-786-8533
Mailing Address - Fax:
Practice Address - Street 1:223 W TOWNLINE ST
Practice Address - Street 2:
Practice Address - City:PAYNE
Practice Address - State:OH
Practice Address - Zip Code:45880-9430
Practice Address - Country:US
Practice Address - Phone:419-786-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171W00000XOther Service ProvidersContractor