Healthcare Provider Details

I. General information

NPI: 1700586435
Provider Name (Legal Business Name): EMIKO WENNERHOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12503 SPRING HILL DR
SPRING HILL FL
34609-5069
US

IV. Provider business mailing address

7570 MEDITERRANEAN CT
HUDSON FL
34667-3029
US

V. Phone/Fax

Practice location:
  • Phone: 352-293-3770
  • Fax:
Mailing address:
  • Phone: 727-858-8024
  • 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: