MEDICARE: MUSIC IZZ GROOVY - MUSIC SERVICES, 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	:	1205521119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSIC IZZ GROOVY - MUSIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	6659 PEARL RD STE 302
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-3821
Country	:	US
Telephone Number	:	216-202-4803
Fax Number	:

Provider Business Practice Location Address
First Line	:	6659 PEARL RD STE 302
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-3821
Country	:	US
Telephone Number	:	216-202-4803
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ISABELLA MARISSA DONOVAN
Credential	:	MT-BC
Telephone Number	:	440-212-8718

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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