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Angie M Bolom

Occupational Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

4206 Retama Cir, Victoria, TX 77901-2765

PECOS Enrollment

Based on the most recent information from CMS, provider Angie M Bolom does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1831134774
Provider Type
Individual
Full Name
Bolom, Angie M
Title
Mrs.
Credential
OTR

Gender
Female
Sole Proprietor
No
Enumeration Date
6/17/2006
Last Updated
7/14/2009

Contact Information

Practice Location

4206 Retama Cir, Victoria, TX 77901-2765

(361) 582-0611

(361) 582-0555

Mailing Location

4206 Retama Cir, Victoria, TX 77901-2765

(361) 582-0611

(361) 582-0555

Provider Taxonomies

Code	Description	License
Code 225X00000X Primary	Description Occupational Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 111526 Texas

Provider Identifiers

ID	Description	Issuer
ID 164704201	Description Medicaid	Issuer Unlisted Texas

Angie M Bolom

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Boothe, Christina A

Torres, Abigail

Armstrong, Sandra K

Robinson, Christine B

Wartsbaugh, Alison Leigh

Fottral, Sanami Ann

Zidek, Amber Dawn

Sharp, Cameron Lee

Dunn, Amanda Kristin

Seals, Beverly