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General NPI Number Information
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NPI Number | 1598158909
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Entity Type | Organization
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Legal Business Name | MUSIK TO GROW
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 1517 JOHNSON FERRY RD
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City | MARIETTA
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State | GA
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Zip | 30062-6493
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Country | US
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Telephone | 770-579-2554
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Fax |
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Provider Business Mailing Address
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Address Line | 2998 CHRISTOPHERS CT
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City | MARIETTA
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State | GA
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Zip | 30062-1631
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Country | US
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Telephone | 770-579-2554
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Fax |
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Authorized Official
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Title or Position | MUSIC THERAPIST/OWNER
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Name | JANET LYNN BONER
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Credential | MT-BC
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Telephone | 770-579-2554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | MUT000077
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License Number State | GA
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