Provider Demographics
NPI:1992464226
Name:BARTHOLET, MICAYLA ROSE
Entity type:Individual
Prefix:
First Name:MICAYLA
Middle Name:ROSE
Last Name:BARTHOLET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 STURGIS CORNER DR STE 4
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-5617
Mailing Address - Country:US
Mailing Address - Phone:319-430-8232
Mailing Address - Fax:319-351-5754
Practice Address - Street 1:44 STURGIS CORNER DR STE 4
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-5617
Practice Address - Country:US
Practice Address - Phone:319-430-8232
Practice Address - Fax:319-351-5754
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician