MEDICARE: JODIE LYNN WHITE 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	:	1861687139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE LYNN WHITE MT-BC

Provider Business Mailing Address
First Line	:	4529 SISK RD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-2021
Country	:	US
Telephone Number	:	940-687-0962
Fax Number	:

Provider Business Practice Location Address
First Line	:	4529 SISK RD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-2021
Country	:	US
Telephone Number	:	940-687-0962
Fax Number	:

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

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

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