Provider Demographics
NPI:1346439205
Name:BOUBELEVA, IRINA N (LMT, MS)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:N
Last Name:BOUBELEVA
Suffix:
Gender:F
Credentials:LMT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 BELLTREE DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3504
Mailing Address - Country:US
Mailing Address - Phone:614-571-7190
Mailing Address - Fax:
Practice Address - Street 1:815 N HIGH ST
Practice Address - Street 2:STUDIO M
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1486
Practice Address - Country:US
Practice Address - Phone:614-571-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.013746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist