Healthcare Provider Details

I. General information

NPI: 1508477506
Provider Name (Legal Business Name): MAURIZIO EMANUELE MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 N UNION CITY RD
COLDWATER MI
49036-9228
US

IV. Provider business mailing address

836 N UNION CITY RD
COLDWATER MI
49036-9228
US

V. Phone/Fax

Practice location:
  • Phone: 734-363-5672
  • Fax:
Mailing address:
  • Phone: 734-363-5672
  • 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: