Provider Demographics
NPI:1245013879
Name:EAGLE, CHEYENNA RAIN (MT-BC)
Entity type:Individual
Prefix:
First Name:CHEYENNA
Middle Name:RAIN
Last Name:EAGLE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STONEHEDGE CIR APT B
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-1252
Mailing Address - Country:US
Mailing Address - Phone:585-331-6616
Mailing Address - Fax:
Practice Address - Street 1:160 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1240
Practice Address - Country:US
Practice Address - Phone:617-484-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist