=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053701417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PALM BEACH MUSIC THERAPY INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2015
-----------------------------------------------------
Last Update Date | 01/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11701 LAKE VICTORIA GARDENS AVE SUITE 2202
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-747-9944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11701 LAKE VICTORIA GARDENS AVE SUITE 2202
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-747-9944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MUSIC THERAPIST AND FOUNDER
-----------------------------------------------------
Name | CATHERINE NIELSEN
-----------------------------------------------------
Credential | MT-BC
-----------------------------------------------------
Telephone | 561-324-0743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225A00000X
-----------------------------------------------------
Taxonomy Name | Music Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------