MEDICARE: CINDY LOU NELSON MPS, ATR-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	221700000X	Art Therapist

General Provider Information

NPI Number	:	1629288022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY LOU NELSON MPS, ATR-BC

Provider Business Mailing Address
First Line	:	PO BOX 604
Second Line	:
City	:	LEBANON
State	:	NJ
Zip	:	08833-0604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 BRIGHT ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4342
Country	:	US
Telephone Number	:	201-369-3779
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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