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General NPI Number Information
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NPI Number | 1598592610
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Entity Type | Individual
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Provider Name | KAITLEN VIRGINIA FLYNN MTBC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2024
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Last Update Date | 09/14/2024
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Provider Practice Location Address
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Address Line | 1669 W MAPLE RD
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City | BIRMINGHAM
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State | MI
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Zip | 48009-1230
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Country | US
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Telephone | 248-646-3347
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Fax | 248-646-4480
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Provider Business Mailing Address
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Address Line | 473 KIRTS BLVD APT 60
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City | TROY
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State | MI
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Zip | 48084-5264
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Country | US
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Telephone | 630-277-3256
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 17845
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License Number State | IL
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