Healthcare Provider Details

I. General information

NPI: 1174830764
Provider Name (Legal Business Name): JAMES MONTMINY DANNA BA, MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 KENYON AVE
WAKEFIELD RI
02879-4213
US

IV. Provider business mailing address

125 LEGEND ROCK RD
WAKEFIELD RI
02879-7708
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-4810
  • Fax:
Mailing address:
  • Phone: 401-441-8114
  • 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: