=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699530543
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY HOLSEN MT-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2024
-----------------------------------------------------
Last Update Date | 02/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1728 HICKORY DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53705-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-440-0475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1728 HICKORY DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53705-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-440-0475
-----------------------------------------------------
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 | 18683
-----------------------------------------------------
License Number State |
-----------------------------------------------------