Healthcare Provider Details

I. General information

NPI: 1245013879
Provider Name (Legal Business Name): CHEYENNA RAIN EAGLE MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LEXINGTON ST
BELMONT MA
02478-1240
US

IV. Provider business mailing address

2 STONEHEDGE CIR APT B
BILLERICA MA
01821-1252
US

V. Phone/Fax

Practice location:
  • Phone: 617-484-4696
  • Fax:
Mailing address:
  • Phone: 585-331-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: