Provider Demographics
NPI:1730773771
Name:BOKENO, MEGHAN (MT-BC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:BOKENO
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 1:12 LAKE CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4478
Mailing Address - Country:US
Mailing Address - Phone:720-933-9057
Mailing Address - Fax:
Practice Address - Street 1:12 LAKE CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4478
Practice Address - Country:US
Practice Address - Phone:720-933-9057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHMUS.24000336225A00000X
225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMUS.24000336OtherCSWMFT BOARD
11306OtherCERTIFICATION BOARD FOR MUSIC THERAPISTS