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General NPI Number Information
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NPI Number | 1356655393
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Entity Type | Organization
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Legal Business Name | WESTERN WISCONSIN MUSIC IN MEDICINE, LLC
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | S806 COUNTY ROAD H
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City | MONDOVI
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State | WI
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Zip | 54755-8210
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Country | US
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Telephone | 715-495-3768
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Fax | 715-926-5137
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Provider Business Mailing Address
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Address Line | S 806 COUTY ROAD H
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City | MONDOVI
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State | WI
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Zip | 54755-8210
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Country | US
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Telephone | 715-495-3768
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Fax | 715-926-5137
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Authorized Official
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Title or Position | DIRECTOR
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Name | KIMBERLY NEGUS
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Credential | COTA-NMT/L
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Telephone | 715-495-3768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 28038
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 1617-27
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 718241
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2363-26
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License Number State | WI
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