MEDICARE: THE HOUSE OF MUSIC THERAPY, LLC

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	:	1053939926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HOUSE OF MUSIC THERAPY, LLC

Provider Business Mailing Address
First Line	:	5576 SIX MILE COMMERCIAL CT APT 107
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4496
Country	:	US
Telephone Number	:	239-308-0424
Fax Number	:	239-207-3442

Provider Business Practice Location Address
First Line	:	5576 SIX MILE COMMERCIAL CT APT 107
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4496
Country	:	US
Telephone Number	:	239-308-0424
Fax Number	:	239-207-3442

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	CHRISTOPHER NEAL HOWARD
Credential	:	MBA
Telephone Number	:	337-384-8758

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/08/2020

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