Healthcare Provider Details

I. General information

NPI: 1598158909
Provider Name (Legal Business Name): MUSIK TO GROW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 JOHNSON FERRY RD
MARIETTA GA
30062-6493
US

IV. Provider business mailing address

2998 CHRISTOPHERS CT
MARIETTA GA
30062-1631
US

V. Phone/Fax

Practice location:
  • Phone: 770-579-2554
  • Fax:
Mailing address:
  • Phone: 770-579-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberMUT000077
License Number StateGA

VIII. Authorized Official

Name: JANET LYNN BONER
Title or Position: MUSIC THERAPIST/OWNER
Credential: MT-BC
Phone: 770-579-2554