Healthcare Provider Details

I. General information

NPI: 1649749789
Provider Name (Legal Business Name): MAXWELL CORRIGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST # MP309
ORLANDO FL
32806-2032
US

IV. Provider business mailing address

120 W AMERICA ST APT 7
ORLANDO FL
32801-3636
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3714
  • Fax:
Mailing address:
  • Phone: 651-341-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: