MEDICARE: CAPITAL CREATIVE THERAPY, LLC

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	:	1861085425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL CREATIVE THERAPY, LLC

Provider Business Mailing Address
First Line	:	776 N ORANGE AVE APT 5211
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-7322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	776 N ORANGE AVE APT 5211
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-7322
Country	:	US
Telephone Number	:	407-914-9881
Fax Number	:

Authorized Official
Title or Position	:	MUSIC THERAPIST
Name	:	MR. CHRISTOPHER VILCA
Credential	:	MT-BC
Telephone Number	:	407-914-9881

Provider Enumeration Date	:	02/15/2021
Last Update Date	:	02/15/2021

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