MEDICARE: MICHAEL TOLORUNLEKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist		TX

General Provider Information

NPI Number	:	1396304606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TOLORUNLEKE

Provider Business Mailing Address
First Line	:	PO BOX 79037
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77279-9037
Country	:	US
Telephone Number	:	443-467-7358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 S KIRKWOOD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6238
Country	:	US
Telephone Number	:	443-467-7358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	06/10/2019

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Directions to “ MICHAEL TOLORUNLEKE ” Practice Location

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