Healthcare Provider Details

I. General information

NPI: 1295655207
Provider Name (Legal Business Name): DYNAMIC MUSIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 220TH AVE
MILLTOWN WI
54858-2801
US

IV. Provider business mailing address

PO BOX 3
MILLTOWN WI
54858-0003
US

V. Phone/Fax

Practice location:
  • Phone: 612-424-0342
  • Fax:
Mailing address:
  • Phone: 612-424-0342
  • 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: TATUM KLINE
Title or Position: FOUNDER
Credential: MT-BC
Phone: 612-424-0342