Maya Brianna Bolak

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

16941 N Eagle River Loop Rd
Eagle River, AK 99577-7824

Phone

(907) 726-5330

NPI assigned

Sep 13, 2018

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 13, 2018.

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536796800000",
    "number": "1982187092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24550 PARK DR",
            "city": "CHUGIAK",
            "state": "AK",
            "postal_code": "995676225",
            "telephone_number": "907-406-7430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16941 N EAGLE RIVER LOOP RD",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777824",
            "telephone_number": "907-726-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAK",
        "first_name": "MAYA",
        "middle_name": "BRIANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-13",
        "last_updated": "2018-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APPLIED BEHAVIOR ANALYSIS",
            "identifier": "RBT-18-9999",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Benzschawel
• Elisa Renee Betson, RBT
• Brooke Erin Bialoblocki, OTD
• Thomas Russell Bird, D.D.S.
• Elise Bishop, FNP-BC
• Emma Naomi Boswell, M.A., CCC-SLP
• Rachel Boudreau, LCSW
• Rebecca Anne Bourque
• Casey Bowen, DMD
• Brendon Boyd, DPT

• All providers in Eagle River, AK
• Behavior Technician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.

Verify at the official NPI Registry.