Healthcare Provider Details

I. General information

NPI: 1992149983
Provider Name (Legal Business Name): ALLISON RENE HAYWARD MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON RENE COTNER MT-BC

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 PISA DR APT 1123
ORLANDO FL
32810-2145
US

IV. Provider business mailing address

8625 PISA DR APT 1123
ORLANDO FL
32810-2145
US

V. Phone/Fax

Practice location:
  • Phone: 765-721-7855
  • Fax:
Mailing address:
  • Phone: 765-721-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09881
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: