=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053843011
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE MONICA BURNS MT-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2050 W CHESTER PIKE STE 115
-----------------------------------------------------
City | HAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19083-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-449-9669
-----------------------------------------------------
Fax | 610-449-5566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1605 BRENT RD
-----------------------------------------------------
City | ORELAND
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19075-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-692-2334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225A00000X
-----------------------------------------------------
Taxonomy Name | Music Therapist
-----------------------------------------------------
License Number | 12435
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------