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General NPI Number Information
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NPI Number | 1245192889
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Entity Type | Individual
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Provider Name | MS. AUTUMN MARIE BOCKHOL
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1363 DOUGLAS DR STE 104
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City | TRAVERSE CITY
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State | MI
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Zip | 49696-8980
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Country | US
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Telephone | 231-272-2472
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Fax |
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Provider Business Mailing Address
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Address Line | 2211 BETSIE RIVER RD
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City | INTERLOCHEN
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State | MI
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Zip | 49643-9279
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Country | US
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Telephone | 231-631-3387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | MI
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