Provider Demographics
NPI:1801429675
Name:BOYDSTON-MULHOLLAND, MICHELLE SUZANNE (COTA/L)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:BOYDSTON-MULHOLLAND
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1814
Mailing Address - Country:US
Mailing Address - Phone:406-690-7312
Mailing Address - Fax:
Practice Address - Street 1:820 3RD AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-2023
Practice Address - Country:US
Practice Address - Phone:406-628-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4301100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant