MEDICARE: MRS. AMY MICHELE DACUAG MT-BC

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

General Provider Information

NPI Number	:	1467812313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY MICHELE DACUAG MT-BC

Provider Business Mailing Address
First Line	:	6319 BROOKLYN AVE NE APT B
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-6731
Country	:	US
Telephone Number	:	425-802-1686
Fax Number	:

Provider Business Practice Location Address
First Line	:	6319 BROOKLYN AVE NE APT B
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-6731
Country	:	US
Telephone Number	:	425-802-1686
Fax Number	:

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

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	03/03/2016

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