Healthcare Provider Details

I. General information

NPI: 1427345602
Provider Name (Legal Business Name): ALLISON THOMAS MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 RIVER RUN TRL APT D
FORT WAYNE IN
46825-5986
US

IV. Provider business mailing address

5826 LEESVILLE PL
FORT WAYNE IN
46835-4468
US

V. Phone/Fax

Practice location:
  • Phone: 260-409-8246
  • Fax:
Mailing address:
  • Phone: 604-098-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09544
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: