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General NPI Number Information
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NPI Number | 1942055199
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Entity Type | Individual
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Provider Name | TAYLOR RAE LUIZ LPMT, MT-BC
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Gender | Female
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 1001 MACY DR
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City | ROSWELL
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State | GA
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Zip | 30076-6335
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Country | US
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Telephone | 706-748-1941
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HIGHLAND PARK TRL APT 602
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-3389
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Country | US
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Telephone | 706-748-1941
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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 | MUT000331
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License Number State | GA
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