Healthcare Provider Details

I. General information

NPI: 1629987102
Provider Name (Legal Business Name): ISABELLA SMITH MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 MILL RD
EAST AURORA NY
14052-2835
US

IV. Provider business mailing address

935 MILL RD
EAST AURORA NY
14052-2835
US

V. Phone/Fax

Practice location:
  • Phone: 716-790-0638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number20451
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: