Healthcare Provider Details

I. General information

NPI: 1861617805
Provider Name (Legal Business Name): KIM ROBERTSON MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

9602 E 77TH TER
RAYTOWN MO
64138-1733
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3776
  • Fax:
Mailing address:
  • Phone: 816-358-4787
  • 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: