Individual provider · NPI-1

Amy Caryn Bolenbaugh, CTRS

Recreation Therapist · Los Angeles, CA

NPI number1699293910
StatusActive
Last updated in NPPESSep 7, 2017

Details

NPI
1699293910
Entity type
Individual (NPI-1)
Name
Mrs. Amy Caryn Bolenbaugh
Credential
CTRS
Sex
Female
Sole proprietor
Yes
Enumeration date
Sep 7, 2017
Last updated
Sep 7, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225800000X Recreation Therapist––Yes

Practice location

1720 E 120th Street
Los Angeles, CA 90059

Phone 424-338-2430

Mailing address

1720 E 120th St
Los Angeles, CA 90059-3052

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