Active NPI
Cheyenne Tayler Bolenbaugh, CTRS
- Recreation Therapist
- Jackson, MI
National Provider Identifier
1952896672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 80603
- Practice address
- 7537 Lee Rd Apt B
Jackson, MI 49201-8152 - Phone
- (517) 554-1491
- NPI assigned
- Jun 25, 2018
- Last updated
- Jun 25, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 80603 | MI | Primary |
Addresses
Primary practice location
7537 Lee Rd Apt B
Jackson, MI 49201-8152
Mailing address
7537 Lee Rd Apt B
Jackson, MI 49201-8152
Phone (517) 554-1491
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80603 | MI | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529884800000",
"number": "1952896672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7537 LEE RD APT B",
"city": "JACKSON",
"state": "MI",
"postal_code": "492018152",
"telephone_number": "517-554-1491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7537 LEE RD APT B",
"city": "JACKSON",
"state": "MI",
"postal_code": "492018152",
"telephone_number": "517-554-1491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLENBAUGH",
"first_name": "CHEYENNE",
"middle_name": "TAYLER",
"credential": "CTRS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-25",
"last_updated": "2018-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "MI",
"license": "80603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.