Individual
CHEYENNE TAYLER BOLENBAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
7537 LEE RD APT B, JACKSON, MI 49201-8152
(517) 554-1491
Mailing address
7537 LEE RD APT B, JACKSON, MI 49201-8152
(517) 554-1491
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
80603
MI
Other
Enumeration date
06/25/2018
Last updated
06/25/2018
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