=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639746514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATARINA ELISE HOCK MT-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2021
-----------------------------------------------------
Last Update Date | 06/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 ERDMAN WAY
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-840-9354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 CAMPBELL AVE
-----------------------------------------------------
City | AIRMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10901-6405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-548-5309
-----------------------------------------------------
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 | 16607
-----------------------------------------------------
License Number State |
-----------------------------------------------------