MEDICARE: MELODY MUSIC THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1013508365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELODY MUSIC THERAPY

Provider Business Mailing Address
First Line	:	1872 CHEROKEE ROSE CIR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1872 CHEROKEE ROSE CIR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8003
Country	:	US
Telephone Number	:	571-246-7210
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MUSIC THERAPIST
Name	:	SABRINA CLARK
Credential	:
Telephone Number	:	571-246-7210

Provider Enumeration Date	:	01/29/2021
Last Update Date	:	01/29/2021

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